ACL reconstruction (ACLR) is a commonly performed orthopedic procedure, yet revision surgeries often face failure rates as high as 30%, frequently due to anatomical factors like increased posterior tibial slope (PTS), which may add strain on the graft. Anterior closing wedge osteotomy (ACWO) has been introduced in ACLR revisions to reduce PTS and decrease associated shear forces. ACWO can be performed at three different starting points—supra-tuberosity, trans-tuberosity, and infra-tuberosity—each with unique implications for bone resection height.

This study used PeekMed® preoperative planning software to simulate ACWO at these three osteotomy levels and analyze the resulting impact on bone resection height. This blog post presents the detailed findings of these simulations, providing readers with insights into how osteotomy levels affect bone resection requirements. By examining these factors, readers will understand the influence of different ACWO approaches and their potential benefits in improving ACLR outcomes.

Understanding the Study and its Implications for ACL Reconstruction Surgery:

For patients undergoing revision anterior cruciate ligament (ACL) reconstruction (ACLR), anterior closing wedge osteotomy (ACWO) has become a key technique to reduce posterior tibial slope (PTS) and support graft longevity. However, one aspect that has lacked detailed exploration is how the starting point of the osteotomy affects the amount of bone resection required, potentially impacting the surgical outcome and long-term joint stability. A recent study explores this critical variable, concluding that more distal starting points in ACWO lead to greater bone resection, which provides essential guidance for surgical planning.

Key Findings: The Relationship Between Starting Points and Bone Resection

This study examined 52 patients who had undergone ACWO and were analyzed through a preoperative simulation. Patients were categorized by three different starting points for osteotomy: supra-tuberosity, trans-tuberosity, and infra-tuberosity. Results showed a clear positive correlation between the starting point's proximity to the distal end and the bone resection height. Specifically:

• Supra-tuberosity: 7.5 mm mean resection height
• Trans-tuberosity: 8.0 mm mean resection height
• Infra-tuberosity: 9.2 mm mean resection height
  
  

These findings underscore the need for precise starting-point selection based on each patient's anatomy, as well as considerations of future procedures, such as high tibial osteotomy or even knee arthroplasty.

The Role of PeekMed in Enhancing Preoperative Planning

PeekMed, a powerful 3D preoperative planning software, was instrumental in this study’s simulations, providing an accurate analysis of bone structure and joint alignment. By using PeekMed's simulation capabilities, surgeons were able to visualize each osteotomy approach and assess the bone resection required for each technique. The software’s semi-automated analysis allowed for precise measurements on lateral X-rays, and calculations of PPTA were executed with high reproducibility and accuracy.

PeekMed’s role extended beyond planning, as it equipped surgeons with the data needed to weigh factors like bone conservation, patellar height impact, and ACL tunnel placement in revision cases. In this way, PeekMed has significantly enhanced decision-making accuracy in ACWO, supporting better outcomes for ACL reconstruction patients by offering more reliable preoperative simulations.

Clinical Relevance: Enhanced Outcomes Through Tailored Approaches

The findings of this study offer practical guidance for orthopedic surgeons, helping them choose the most suitable ACWO technique based on individual patient anatomy. The correlation between more distal osteotomy starting points and increased bone resection height emphasizes the need for careful preoperative planning. By selecting the appropriate starting point, surgeons can optimize bone resection and preserve bone stock, which is especially important for younger patients who may require additional knee surgeries in the future.

With advanced tools like PeekMed, surgeons can model different osteotomy scenarios before surgery, minimizing potential complications and refining ACL reconstruction techniques. This research reinforces the value of personalized surgical approaches, supported by data-driven tools, in achieving the best possible clinical outcomes for ACLR revision patients.