INTRODUCTION AND IMPORTANCE: Surface osteosarcoma, a rare variant of osteosarcoma, poses unique challenges in diagnosis and treatment. This report discusses the application of 3D printing technology in the surgical management of a complex case involving a 27-year-old female patient with surface osteosarcoma in the proximal tibia. CASE PRESENTATION: A 27-year-old female patient presented with a progressively growing mass on her right knee, initially misdiagnosed as a benign bone tumor. Over five years, the lesion expanded from a well-corticated metaphyseal-epiphyseal outgrowth on the proximal tibia to involve the anterior tibial tuberosity. Radiological and histological evaluations confirmed well-differentiated paraosteal surface osteosarcoma. A multidisciplinary team opted for a conservative surgical approach, including resection of the anterior tibial tuberosity and patellar tendon. Precision was enhanced through 3D printing technology, which provided custom cutting guides. The reconstruction involved non-vascularized peroneus and iliac crest bone grafts. CLINICAL DISCUSSION: Accurate differentiation from benign lesions presents challenges. Achieving surgical resection with clear margins is pivotal for favourable outcomes, particularly in young patients. Chemotherapy yields limited benefits in low-grade surface osteosarcomas. Functional prognosis hinges on effective post-resection reconstruction. 3D printing technology facilitates meticulous surgical planning and guidance, enhancing the success of conservative surgical interventions. CONCLUSION: This case underscores the significance of a multidisciplinary approach, accurate diagnosis, and the integration of 3D printing technology in managing surface osteosarcomas. Conservative surgical resection, guided by precise planning and reconstruction, is critical for preserving functionality. Continued research and the adoption of innovative techniques hold promise for improving the quality of life and functional outcomes of individuals grappling with musculoskeletal tumors.