Application progress of customized steel plates in osteotomy and orthopedic treatment of knee osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIA Jingkun ^1,2 , MA Jianxiong ¹ ,  MA Xinlong ¹

1. Tianjin Hospital (Tianjin University Tianjin Hospital), Tianjin Orthopedic Research Institute, Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, P. R. China;
2. Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300211, P. R. China;

Corresponding author：

MA Xinlong, Email: maxinlong8686@sina.com

Keywords：

Customized steel plates; osteotomy correction therapy; knee osteoarthritis; clinical application

DOI：

10.7507/1002-1892.202506082

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the application progress of customized steel plates in osteotomy correction therapy for knee osteoarthritis (KOA), and provide reference for orthopedic surgeons and researchers. Methods Extensive review of the literature on customized steel plates for osteotomies and knee-preserving surgeries for KOA, 2015-2025, with an overview of the principles of customized plate design, clinical applications, and future directions, describing their advantages and shortcomings. Results Customized steel plates have demonstrated many advantages in osteotomy correction therapy of KOA, which not only enhance surgical outcomes and optimize mechanical properties, but also reduce the incidence of postoperative complications. However, high cost, long manufacturing period, and selection of patient indications are still important factors restricting their use. Conclusion Customized steel plates show promising potential in treating KOA. Not only do they reduce surgical duration and enhance postoperative healing outcomes, but they also effectively lower the incidence of postoperative complications, thereby improving patients' quality of life.

1.	Zhang H, Fan Y, Wang R, et al. Research trends and hotspots of high tibial osteotomy in two decades (from 2001 to 2020): a bibliometric analysis. J Orthop Surg Res, 2020, 15(1): 512. doi: 10.1186/s13018-020-01991-1.
2.	Herman BV, Giffin JR. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis. J Orthop Traumatol, 2016, 17(3): 277-285.
3.	Kayaalp ME, Apseloff NA, Lott A, et al. Around-the-knee osteotomies part 1: definitions, rationale and planning-state of the art. J ISAKOS, 2024, 9(4): 645-657.
4.	Liang H, Zhang H, Chen B, et al. 3D printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle. Sci Rep, 2023, 13(1): 22667. doi: 10.1038/s41598-023-49515-1.
5.	Alemayehu DG, Zhang Z, Tahir E, et al. Preoperative planning using 3D printing technology in orthopedic surgery. Biomed Res Int, 2021, 2021: 7940242. doi: 10.1155/2021/7940242.
6.	Meng M, Wang J, Huang H, et al. 3D printing metal implants in orthopedic surgery: Methods, applications and future prospects. J Orthop Translat, 2023, 42: 94-112.
7.	Park HJ, Suh DH, Hong H, et al. Biomechanical evaluation of a newly designed locking plate for opening wedge high tibial osteotomy: stress distribution and stability in the presence of lateral hinge fracture. J Orthop Surg Res, 2024, 19(1): 800. doi: 10.1186/s13018-024-05283-w.
8.	Xu Z, Xu W, Zhang T, et al. Mechanisms of tendon-bone interface healing: biomechanics, cell mechanics, and tissue engineering approaches. J Orthop Surg Res, 2024, 19(1): 817. doi: 10.1186/s13018-024-05304-8.
9.	Omid R, Trasolini NA, Stone MA, et al. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg, 2021, 29(11): e523-e535.
10.	Yao Y, Yuan H, Huang H, et al. Biomechanical design and analysis of auxetic pedicle screw to resist loosening. Comput Biol Med. 2021, 133: 104386. doi: 10.1016/j.compbiomed.2021.104386.
11.	Schader J F, Mischler D, Dauwe J, et al. One size may not fit all: patient-specific computational optimization of locking plates for improved proximal humerus fracture fixation. J Shoulder Elbow Surg. 2022, 31(1): 192-200.
12.	Hughes JM, Castellani CM, Popp KL, et al. The central role of osteocytes in the four adaptive pathways of bone's mechanostat. Exerc Sport Sci Rev, 2020, 48(3): 140-148.
13.	Augat P, Hollensteiner M, von Rüden C. The role of mechanical stimulation in the enhancement of bone healing. Injury, 2021, 52 Suppl 2: S78-S83.
14.	Szabo E, Rimnac C. Biomechanics of immature human cortical bone: a systematic review. J Mech Behav Biomed Mater, 2022, 125: 104889. doi: 10.1016/j.jmbbm.2021.104889.
15.	Orrego S, Chen Z, Krekora U, et al. Bioinspired materials with self-adaptable mechanical properties. Adv Mater. 2020, 32(21): e1906970. doi: 10.1002/adma.201906970.
16.	Yao Y, Mo Z, Wu G, et al. A personalized 3D-printed plate for tibiotalocalcaneal arthrodesis: Design, fabrication, biomechanical evaluation and postoperative assessment. Comput Biol Med, 2021 Jun: 133: 104368. doi: 10.1016/j.compbiomed.2021.104368.
17.	Hinz N, Dehoust J, Munch M, et al. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg, 2022, 48(5): 3541-3560.
18.	Liverani E, Rogati G, Pagani S, et al. Mechanical interaction between additive-manufactured metal lattice structures and bone in compression: implications for stress shielding of orthopaedic implants. J Mech Behav Biomed Mater, 2021, 121: 104608. doi: 10.1016/j.jmbbm.2021.104608.
19.	Lin C, Kang J. Mechanical properties of compact bone defined by the stress-strain curve measured using uniaxial tensile test: a concise review and practical guide. Materials (Basel), 2021, 14(15): 4224. doi: 10.3390/ma14154224.
20.	Cronier P, Pietu G, Dujardin C, et al. The concept of locking plates. Orthop Traumatol Surg Res, 2010. doi: 10.1016/j.otsr.2010.03.008.
21.	Hasami NA, Smeeing DPJ, Pull Ter Gunne AF, et al. Operative fixation of lateral malleolus fractures with locking plates vs nonlocking plates: a systematic review and meta-analysis. Foot Ankle Int, 2022, 43(2): 280-290.
22.	Zdero R, Brzozowski P, Schemitsch EH. Biomechanical design optimization of proximal humerus locked plates: A review. Injury, 2024, 55(2): 111247. doi: 10.1016/j.injury.2023.111247.
23.	Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, et al. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury, 2023, 54(2): 395-404.
24.	van Haeringen MH, Kuijer PPFM, Daams JG, et al. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(7): 3015-3026.
25.	Balaji G, Arokiaraj J, Nithyananth M, et al. Complex post traumatic foot deformities - Outcomes after corrective surgery. J Clin Orthop Trauma, 2020, 11(3): 432-437.
26.	Liu J, Zhang Z, Li P, et al. Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing. Sci Rep, 2024, 14(1): 27064. doi: 10.1038/s41598-024-78702-x.
27.	Cheng X, Liu F, Xiong F, et al. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res. 2019, 14(1): 179. doi: 10.1186/s13018-019-1222-x.
28.	Cerciello S, Ollivier M, Corona K, et al. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 555-566.
29.	Choi N. Editorial Commentary: Knee preoperative medial laxity may result in overcorrection or varus recurrence after open-wedge high tibial osteotomy. Arthroscopy, 2022, 38(5): 1555-1556.
30.	Liu X, Chen Z, Gao Y, et al. High tibial osteotomy: review of techniques and biomechanics. J Healthc Eng. 2019, 2019: 8363128. doi: 10.1155/2019/8363128.
31.	Giuseffi SA, Replogle WH, Shelton WR. Opening-wedge high tibial osteotomy: review of 100 consecutive cases. Arthroscopy, 2015, 31(11): 2128-2137.
32.	Han SB, In Y, Oh KJ, et al. Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty, 2019, 34(3): 439-445.
33.	Yoo OS, Lee YS, Lee MC, et al. Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting. BMC Musculoskelet Disord, 2016, 17(1): 423. doi: 10.1186/s12891-016-1277-3.
34.	Lott A, James MG, Kaarre J, et al. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes—State of the art. J ISAKOS, 2024, 9(4): 658-671.
35.	Coakley A, Mcnicholas M, Biant L, et al. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee, 2023, 40: 97-110.
36.	Cance N, Batailler C, Lording T, et al. Ten-year minimal follow-up of lateral opening wedge distal femoral osteotomy for lateral femorotibial osteoarthritis: Good survivorship and high patient satisfaction. Knee Surg Sports Traumatol Arthrosc, 2025, 33(2): 675-685.
37.	Nguyen DCT, Benameur S, Mignotte M, et al. 3D biplanar reconstruction of lower limbs using nonlinear statistical models. Med Biol Eng Comput, 2023, 61(11): 2877-2894.
38.	Fujita K, Sawaguchi T, Goshima K, et al. Influence of lateral hinge fractures on biplanar medial closing-wedge distal femoral osteotomy for valgus knee: a new classification of lateral hinge fracture. Arch Orthop Trauma Surg, 2023, 143(3): 1175-1183.
39.	Ehlinger M, Favreau H, Murgier J, et al. Knee osteotomies: The time has come for 3D planning and patient-specific instrumentation. Orthop Traumatol Surg Res, 2023, 109(4): 103611. doi: 10.1016/j.otsr.2023.103611.
40.	Koh YG, Lee JA, Lee HY, et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res, 2019, 14(1): 219. doi: 10.1186/s13018-019-1269-8.
41.	Lansdaal JR, Mouton T, Wascher DC, et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(12): 3670-3678.
42.	Depaoli A, Menozzi GC, Di Gennaro GL, et al. The flipping-wedge osteotomy: how 3D virtual surgical planning (VSP) suggested a simple and promising type of osteotomy in pediatric post-traumatic forearm deformity. J Pers Med, 2023, 13(3): 549. doi: 10.3390/jpm13030549.
43.	Pisciotta C, Saveri P, Pareyson D. Challenges in treating Charcot-Marie-Tooth Disease and related neuropathies: current management and future perspectives. Brain Sci, 2021, 11(11): 1447. doi: 10.3390/brainsci11111447.
44.	Daniel AV, Wagner MJ, Levy BA. Editorial Commentary: Various high tibial osteotomy techniques show high survivorship, medial opening-wedge technique has risks, and patient-specific instrumentation shows promise. Arthroscopy, 2025, 41(10): 4165-4167.
45.	Kedadria A, Benaouali A, Gilson L, et al. Numerical design and analysis of customized fixation plate for treating middle one-third clavicle fracture. Comput Methods Biomech Biomed Engin, 2025, 11: 1-11.
46.	Palmer J, Getgood A, Lobenhoffer P, et al. Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: A state-of-the-art review. J ISAKOS, 2024, 9(1): 39-52.
47.	IJpma FFA, Meesters AML, Merema BBJ, et al. Feasibility of imaging-based 3-dimensional models to design patient-specific osteosynthesis plates and drilling guides. JAMA Netw Open, 2021, 4(2): e2037519. doi: 10.1001/jamanetworkopen.2020.37519.
48.	Chen H, Liu Y, Wang C, et al. Design and properties of biomimetic irregular scaffolds for bone tissue engineering. Comput Biol Med, 2021, 130: 104241. doi: 10.1016/j.compbiomed.2021.104241.
49.	Katsuura Y, Qureshi SA. Additive manufacturing for metal applications in orthopaedic surgery. J Am Acad Orthop Surg, 2020, 28(8): e349-e355.
50.	Li J, Cui X, Hooper GJ, et al. Rational design, bio-functionalization and biological performance of hybrid additive manufactured titanium implants for orthopaedic applications: A review. J Mech Behav Biomed Mater, 2020, 105: 103671. doi: 10.1016/j.jmbbm.2020.103671.
51.	Ranaldo D, Zonta F, Florian S, et al. A facile, semi-automatic protocol for the design and production of 3D printed, anatomical customized orthopedic casts for forearm fractures. J Clin Orthop Trauma, 2023, 42: 102206. doi: 10.1016/j.jcot.2023.102206.
52.	Desai KB, Mulpur P, Jayakumar T, et al. Adoption of robotics in arthroplasty-a survey of perceptions, utilization and challenges with technology amongst Indian surgeons. J Orthop, 2023, 46: 51-57.
53.	Liu Y, Du T, Qiao A, et al. Zinc-based biodegradable materials for orthopaedic internal fixation. J Funct Biomater, 2022, 13(4): 164. doi: 10.3390/jfb13040164.
54.	Suljevic O, Fischerauer SF, Weinberg AM, et al. Immunological reaction to magnesium-based implants for orthopedic applications. What do we know so far? A systematic review on in vivo studies. Mater Today Bio, 2022, 15: 100315. doi: 10.1016/j.mtbio.2022.100315.

1. Zhang H, Fan Y, Wang R, et al. Research trends and hotspots of high tibial osteotomy in two decades (from 2001 to 2020): a bibliometric analysis. J Orthop Surg Res, 2020, 15(1): 512. doi: 10.1186/s13018-020-01991-1.
2. Herman BV, Giffin JR. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis. J Orthop Traumatol, 2016, 17(3): 277-285.
3. Kayaalp ME, Apseloff NA, Lott A, et al. Around-the-knee osteotomies part 1: definitions, rationale and planning-state of the art. J ISAKOS, 2024, 9(4): 645-657.
4. Liang H, Zhang H, Chen B, et al. 3D printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle. Sci Rep, 2023, 13(1): 22667. doi: 10.1038/s41598-023-49515-1.
5. Alemayehu DG, Zhang Z, Tahir E, et al. Preoperative planning using 3D printing technology in orthopedic surgery. Biomed Res Int, 2021, 2021: 7940242. doi: 10.1155/2021/7940242.
6. Meng M, Wang J, Huang H, et al. 3D printing metal implants in orthopedic surgery: Methods, applications and future prospects. J Orthop Translat, 2023, 42: 94-112.
7. Park HJ, Suh DH, Hong H, et al. Biomechanical evaluation of a newly designed locking plate for opening wedge high tibial osteotomy: stress distribution and stability in the presence of lateral hinge fracture. J Orthop Surg Res, 2024, 19(1): 800. doi: 10.1186/s13018-024-05283-w.
8. Xu Z, Xu W, Zhang T, et al. Mechanisms of tendon-bone interface healing: biomechanics, cell mechanics, and tissue engineering approaches. J Orthop Surg Res, 2024, 19(1): 817. doi: 10.1186/s13018-024-05304-8.
9. Omid R, Trasolini NA, Stone MA, et al. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg, 2021, 29(11): e523-e535.
10. Yao Y, Yuan H, Huang H, et al. Biomechanical design and analysis of auxetic pedicle screw to resist loosening. Comput Biol Med. 2021, 133: 104386. doi: 10.1016/j.compbiomed.2021.104386.
11. Schader J F, Mischler D, Dauwe J, et al. One size may not fit all: patient-specific computational optimization of locking plates for improved proximal humerus fracture fixation. J Shoulder Elbow Surg. 2022, 31(1): 192-200.
12. Hughes JM, Castellani CM, Popp KL, et al. The central role of osteocytes in the four adaptive pathways of bone's mechanostat. Exerc Sport Sci Rev, 2020, 48(3): 140-148.
13. Augat P, Hollensteiner M, von Rüden C. The role of mechanical stimulation in the enhancement of bone healing. Injury, 2021, 52 Suppl 2: S78-S83.
14. Szabo E, Rimnac C. Biomechanics of immature human cortical bone: a systematic review. J Mech Behav Biomed Mater, 2022, 125: 104889. doi: 10.1016/j.jmbbm.2021.104889.
15. Orrego S, Chen Z, Krekora U, et al. Bioinspired materials with self-adaptable mechanical properties. Adv Mater. 2020, 32(21): e1906970. doi: 10.1002/adma.201906970.
16. Yao Y, Mo Z, Wu G, et al. A personalized 3D-printed plate for tibiotalocalcaneal arthrodesis: Design, fabrication, biomechanical evaluation and postoperative assessment. Comput Biol Med, 2021 Jun: 133: 104368. doi: 10.1016/j.compbiomed.2021.104368.
17. Hinz N, Dehoust J, Munch M, et al. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg, 2022, 48(5): 3541-3560.
18. Liverani E, Rogati G, Pagani S, et al. Mechanical interaction between additive-manufactured metal lattice structures and bone in compression: implications for stress shielding of orthopaedic implants. J Mech Behav Biomed Mater, 2021, 121: 104608. doi: 10.1016/j.jmbbm.2021.104608.
19. Lin C, Kang J. Mechanical properties of compact bone defined by the stress-strain curve measured using uniaxial tensile test: a concise review and practical guide. Materials (Basel), 2021, 14(15): 4224. doi: 10.3390/ma14154224.
20. Cronier P, Pietu G, Dujardin C, et al. The concept of locking plates. Orthop Traumatol Surg Res, 2010. doi: 10.1016/j.otsr.2010.03.008.
21. Hasami NA, Smeeing DPJ, Pull Ter Gunne AF, et al. Operative fixation of lateral malleolus fractures with locking plates vs nonlocking plates: a systematic review and meta-analysis. Foot Ankle Int, 2022, 43(2): 280-290.
22. Zdero R, Brzozowski P, Schemitsch EH. Biomechanical design optimization of proximal humerus locked plates: A review. Injury, 2024, 55(2): 111247. doi: 10.1016/j.injury.2023.111247.
23. Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, et al. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury, 2023, 54(2): 395-404.
24. van Haeringen MH, Kuijer PPFM, Daams JG, et al. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(7): 3015-3026.
25. Balaji G, Arokiaraj J, Nithyananth M, et al. Complex post traumatic foot deformities - Outcomes after corrective surgery. J Clin Orthop Trauma, 2020, 11(3): 432-437.
26. Liu J, Zhang Z, Li P, et al. Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing. Sci Rep, 2024, 14(1): 27064. doi: 10.1038/s41598-024-78702-x.
27. Cheng X, Liu F, Xiong F, et al. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res. 2019, 14(1): 179. doi: 10.1186/s13018-019-1222-x.
28. Cerciello S, Ollivier M, Corona K, et al. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 555-566.
29. Choi N. Editorial Commentary: Knee preoperative medial laxity may result in overcorrection or varus recurrence after open-wedge high tibial osteotomy. Arthroscopy, 2022, 38(5): 1555-1556.
30. Liu X, Chen Z, Gao Y, et al. High tibial osteotomy: review of techniques and biomechanics. J Healthc Eng. 2019, 2019: 8363128. doi: 10.1155/2019/8363128.
31. Giuseffi SA, Replogle WH, Shelton WR. Opening-wedge high tibial osteotomy: review of 100 consecutive cases. Arthroscopy, 2015, 31(11): 2128-2137.
32. Han SB, In Y, Oh KJ, et al. Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty, 2019, 34(3): 439-445.
33. Yoo OS, Lee YS, Lee MC, et al. Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting. BMC Musculoskelet Disord, 2016, 17(1): 423. doi: 10.1186/s12891-016-1277-3.
34. Lott A, James MG, Kaarre J, et al. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes—State of the art. J ISAKOS, 2024, 9(4): 658-671.
35. Coakley A, Mcnicholas M, Biant L, et al. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee, 2023, 40: 97-110.
36. Cance N, Batailler C, Lording T, et al. Ten-year minimal follow-up of lateral opening wedge distal femoral osteotomy for lateral femorotibial osteoarthritis: Good survivorship and high patient satisfaction. Knee Surg Sports Traumatol Arthrosc, 2025, 33(2): 675-685.
37. Nguyen DCT, Benameur S, Mignotte M, et al. 3D biplanar reconstruction of lower limbs using nonlinear statistical models. Med Biol Eng Comput, 2023, 61(11): 2877-2894.
38. Fujita K, Sawaguchi T, Goshima K, et al. Influence of lateral hinge fractures on biplanar medial closing-wedge distal femoral osteotomy for valgus knee: a new classification of lateral hinge fracture. Arch Orthop Trauma Surg, 2023, 143(3): 1175-1183.
39. Ehlinger M, Favreau H, Murgier J, et al. Knee osteotomies: The time has come for 3D planning and patient-specific instrumentation. Orthop Traumatol Surg Res, 2023, 109(4): 103611. doi: 10.1016/j.otsr.2023.103611.
40. Koh YG, Lee JA, Lee HY, et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res, 2019, 14(1): 219. doi: 10.1186/s13018-019-1269-8.
41. Lansdaal JR, Mouton T, Wascher DC, et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(12): 3670-3678.
42. Depaoli A, Menozzi GC, Di Gennaro GL, et al. The flipping-wedge osteotomy: how 3D virtual surgical planning (VSP) suggested a simple and promising type of osteotomy in pediatric post-traumatic forearm deformity. J Pers Med, 2023, 13(3): 549. doi: 10.3390/jpm13030549.
43. Pisciotta C, Saveri P, Pareyson D. Challenges in treating Charcot-Marie-Tooth Disease and related neuropathies: current management and future perspectives. Brain Sci, 2021, 11(11): 1447. doi: 10.3390/brainsci11111447.
44. Daniel AV, Wagner MJ, Levy BA. Editorial Commentary: Various high tibial osteotomy techniques show high survivorship, medial opening-wedge technique has risks, and patient-specific instrumentation shows promise. Arthroscopy, 2025, 41(10): 4165-4167.
45. Kedadria A, Benaouali A, Gilson L, et al. Numerical design and analysis of customized fixation plate for treating middle one-third clavicle fracture. Comput Methods Biomech Biomed Engin, 2025, 11: 1-11.
46. Palmer J, Getgood A, Lobenhoffer P, et al. Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: A state-of-the-art review. J ISAKOS, 2024, 9(1): 39-52.
47. IJpma FFA, Meesters AML, Merema BBJ, et al. Feasibility of imaging-based 3-dimensional models to design patient-specific osteosynthesis plates and drilling guides. JAMA Netw Open, 2021, 4(2): e2037519. doi: 10.1001/jamanetworkopen.2020.37519.
48. Chen H, Liu Y, Wang C, et al. Design and properties of biomimetic irregular scaffolds for bone tissue engineering. Comput Biol Med, 2021, 130: 104241. doi: 10.1016/j.compbiomed.2021.104241.
49. Katsuura Y, Qureshi SA. Additive manufacturing for metal applications in orthopaedic surgery. J Am Acad Orthop Surg, 2020, 28(8): e349-e355.
50. Li J, Cui X, Hooper GJ, et al. Rational design, bio-functionalization and biological performance of hybrid additive manufactured titanium implants for orthopaedic applications: A review. J Mech Behav Biomed Mater, 2020, 105: 103671. doi: 10.1016/j.jmbbm.2020.103671.
51. Ranaldo D, Zonta F, Florian S, et al. A facile, semi-automatic protocol for the design and production of 3D printed, anatomical customized orthopedic casts for forearm fractures. J Clin Orthop Trauma, 2023, 42: 102206. doi: 10.1016/j.jcot.2023.102206.
52. Desai KB, Mulpur P, Jayakumar T, et al. Adoption of robotics in arthroplasty-a survey of perceptions, utilization and challenges with technology amongst Indian surgeons. J Orthop, 2023, 46: 51-57.
53. Liu Y, Du T, Qiao A, et al. Zinc-based biodegradable materials for orthopaedic internal fixation. J Funct Biomater, 2022, 13(4): 164. doi: 10.3390/jfb13040164.
54. Suljevic O, Fischerauer SF, Weinberg AM, et al. Immunological reaction to magnesium-based implants for orthopedic applications. What do we know so far? A systematic review on in vivo studies. Mater Today Bio, 2022, 15: 100315. doi: 10.1016/j.mtbio.2022.100315.

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