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The supratrochlear synovial membrane should be incised and reflected to determine the amount of bone to be removed.
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Drawing the planned trochlear lines with a sterile marking pen to evaluate before performing the osteotomies the planned trochlear groove.
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The use of the offset guide enables to create an osteochondral flap of 5 mm, limiting the risk of cartilage damage.
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Additional subchondral bone should be removed from the metaphyseal part with the burr to decrease the prominence and mold the trochlear flaps.
Pitfalls
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Breakage of the osteochondral flap while performing the three osteotomies.
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Overtensioning of the sutures might lead to suture cut-through on the cartilage and anchor pull-out and cartilage.
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The osteotomy and slight twist of the osteochondral flap around the distal hinge might create a step, which needs to be removed with the surgical blade.