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Considerations of the Posterior Tibial Slope in Anterior Cruciate Ligament Reconstruction: a Scoping Review

  • Outcomes in Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
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Abstract

Purpose of Review

The significance of posterior tibial slope (PTS) in the setting of anterior cruciate ligament (ACL) injury and reconstruction has been increasingly recognized in recent years. The purpose of this article is to review the biomechanical and clinical studies of PTS in conjunction with ACL injuries, providing an evidence-based approach for the evaluation and management of this patient population.

Recent Findings

Several biomechanical and clinical studies suggest that PTS > 12° may be considered with increased strain on the native ACL fibers (or reconstructed graft) and greater anterior tibial translation, predisposing patients to a recurrent ACL injury. The increased rates of ACL injury and graft failure seen in those with increased PTS have garnered attention to diagnose and surgically address increased PTS in the revision ACL setting; however, the role of a slope-reducing high tibial osteotomy (HTO) in primary ACL reconstruction (ACL-R) has yet to be defined. Various HTO techniques to decrease PTS during revision ACL-R have demonstrated promising outcomes, though conclusions are limited by the multifactorial nature of revision surgery and concomitant procedures performed.

Summary

Recent evidence suggests that increased PTS is a risk factor for failure following ACL-R, which may be mitigated by a slope-reducing HTO. Further investigation is needed to elucidate abnormal PTS values and to determine appropriate indications for a slope-reducing HTO in primary ACL-R.

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Authors and Affiliations

  1. UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA

    Ehab M. Nazzal, Bálint Zsidai, Oriol Pujol, Janina Kaarre, Andrew J. Curley & Volker Musahl

  2. Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Bálint Zsidai & Janina Kaarre

  3. Orthopedic Surgery Department, Vall d’Hebron University Hospital, Barcelona, Spain

    Oriol Pujol

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  1. Ehab M. Nazzal
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Correspondence to Ehab M. Nazzal.

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Volker Musahl is a paid consultant for Smith & Nephew. Ehab Nazzal, Bálint Zsidai, Oriol Pujol, Janina Kaarre, and Andrew Curley declare that they have no conflict of interest

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Nazzal, E.M., Zsidai, B., Pujol, O. et al. Considerations of the Posterior Tibial Slope in Anterior Cruciate Ligament Reconstruction: a Scoping Review. Curr Rev Musculoskelet Med 15, 291–299 (2022). https://doi.org/10.1007/s12178-022-09767-2

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