Two vs. Four K-Wires: What's Better for ACL Surgery?

Ever wondered how many K-wires make a difference in ACL surgery? Well, let's dive in! Patients with a re-torn ACL and a steep tibial slope (over 12°) often need a procedure called anterior tibial closing wedge osteotomy (ATCWO). While this helps lower failure rates in revision surgeries, it might slightly change the leg's shape, leading to a varus knee. Why? Because using just two guide wires to set the osteotomy plane might subtly affect the medial proximal tibial angle (MPTA). But what if we used four guide wires instead? We think it could reduce this impact! Research shows that a high tibial slope can strain the ACL, causing it to tear again. ATCWO helps by flattening the slope, making the knee more stable. However, when only two guide wires are used, the cut might not be perfect, which could lead to a slight varus knee. But using four guide wires could possibly improve the cut's accuracy, keeping the leg's natural shape. Could this simple change make a big difference? Maybe. But it's not just about changing the number of wires. It's about understanding how each decision, no matter how small, can influence the surgery's outcome. After all, every wire, every cut, every angle matters!