High tibial osteotomy with virtual planning and patient specific instrumentation: a narrative review

PSI represents a significant advancement in the execution of high tibial osteotomies, offering increased surgical accuracy, reduced radiation exposure, and enhanced procedural efficiency. It holds particular value in complex or multiplanar deformities where traditional techniques are limited. Although cost and hinge fracture data remain areas for further investigation, the growing body of evidence supports PSI's clinical utility and reproducibility. As 3D planning technologies and guided manufacturing become more accessible, PSI is well-positioned to become a standard adjunct in knee realignment procedures.