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Many injuries to the cervical spine can be treated conservatively. Treatment options include early functional, mobilizing and immobilizing procedures. If a structural injury can be ruled out by morphological imaging, early functional mobilization should be performed in combination with adequate analgesia according to the World Health Organization (WHO) step by step scheme to avoid chronification. If a structural injury to the cervical spine is present, a stability test is crucial for the decision on treatment. Stable fractures include, for example, types I, II and V fractures of the atlas according to Gehweiler, types I and III fractures of the dens axis according to Anderson and D'Alonzo and type A fractures of the subaxial cervical spine according to the AO. If the results of the imaging examination are inconclusive, functional imaging should be performed. If the injury is stable, external immobilization can be used for conservative treatment. Semirigid and rigid cervical orthotic devices as well as Minerva corsets and the halo fixator are available for this purpose. The degree of immobilization increases with the invasiveness of the procedure. Immobilization should be carried out under clinical and radiological monitoring until the injury has healed. An increase or persistence of symptoms during conservative treatment indicates treatment failure and should result in follow-up imaging. Immobilizing treatment should also be accompanied by isometric physiotherapeutic exercise and adequate analgesic treatment. In adult patients the external stabilization should be gradually reduced through physiotherapeutic exercise after completion of the immobilization treatment., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: L. Viezens ist als Referent für DePuy Synthes und Medtronic tätig. C. Arras, J. Kylies und L.-G. Leonhardt geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: Anterior tibial closing wedge osteotomy (ATCWO) has been shown to significantly reduce failure rates of revision anterior cruciate ligament (ACL) reconstructions in patients with a posterior tibial slope (PTS) ≥12°. Recent findings suggest a slight but significant reduction of the medial proximal tibial angle (MPTA) resulting in a varus knee where the sagittal osteotomy plane is based on a total of two guide wires defining the osteotomy wedge without respecting the frontal plane. We hypothesize that the placement of a total of four guide wires intraoperatively can reduce the influence on the MPTA., Methods: This study retrospectively reports on a two-centre series of 42 ATCWOs for PTS correction between January 2022 and December 2023 at two clinical centres. A total of four guide wires were placed based on a true lateral intraoperative view of the tibia, with two positioned each at the cranial and at the caudal pole of the osteotomy wedge, serving as guides for the saw to create the osteotomy, with careful attention to ensuring that the proximal and distal K-Wires were placed parallel to each other. A retrospective analysis was conducted by examining true lateral and anteroposterior radiographs to identify changes in sagittal and coronal plane alignment., Results: The study included 19 women and 23 men, with a mean age of 29.7 ± 8.6 years with first-time ACL revision surgery and a minimum PTS of ≥12°. PTS decreased significantly from 14.5 ± 2.8° preoperatively to 8.2 ± 1.9° post-operatively ( p  < 0.001). The aMPTA demonstrated no significant difference between preoperative (mean aMPTA: 86.9 ± 2.1°) and post-operative (mean aMPTA: 86.6 ± 1.9°) measurements ( p  > 0.05)., Conclusion: With our technique of placing four guide wires to achieve precise guidance during the insertion of the osteotomy wedge, there is no substantial impact on the aMPTA during slope correction., Level of Evidence: Level IV., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)