Influence of Posterior Tibial Slope on Clinical Outcomes and Survivorship After Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Minimum of 10-Year Follow-Up

Editorial Commentary: Remember the Risk Factors During Individualized, Anatomic, Value-Based Anterior Cruciate Ligament Reconstruction

“…As the authors identify, tibial slope has long been understood to be a risk factor for failed ACL reconstruction. 1,17 Osteotomy is not routinely performed at time of primary ACL reconstruction but may be considered in the setting of multiple failed ACL reconstructions. Although some studies also recommend routine lateral sided extraarticular tenodesis for certain patients to reduce failure rates, we have found similarly low levels of failure following isolated individualized anatomic ACL reconstruction in our prospective randomized trials.…”

High Tibial Osteotomy for Varus Deformity of the Knee

“… 12 In contrast, the sagittal alignment represented by the PTS has a biomechanically and clinically proven impact on ACL graft forces and ACL reconstruction failure rates. 1 , 13 , 14 A positive linear correlation between PTS and ACL graft forces was demonstrated, 1 which is reflected in significantly higher failure rates after ACL reconstruction in patients with increased PTS. 13 , 14 Consequently, slope-reducing osteotomies have been recommended in the treatment of multiple failed ACL reconstructions in patients with increased PTS and should be a component of any varus correction in the setting of revision ACL reconstruction with concomitant osteotomy.…”

“… 1 , 13 , 14 A positive linear correlation between PTS and ACL graft forces was demonstrated, 1 which is reflected in significantly higher failure rates after ACL reconstruction in patients with increased PTS. 13 , 14 Consequently, slope-reducing osteotomies have been recommended in the treatment of multiple failed ACL reconstructions in patients with increased PTS and should be a component of any varus correction in the setting of revision ACL reconstruction with concomitant osteotomy. 15 Regarding valgus producing HTO, the PTS needs to be assessed preoperatively and monitored intraoperatively to avoid an unwanted or unintended change in the PTS.…”

Editorial Commentary: Respect the Posterior Tibial Slope and Make Slope-Reducing Osteotomies an Integral Part of the Surgical Repertoire

“…W e commend the authors Yoon, Park, Park, Kim, Kim, Kwon, and Kim on their recent publication entitled "Influence of Posterior Tibial Slope on Clinical Outcomes and Survivorship After Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Minimum of 10-Year Follow-Up." 1 In their retrospective study, the influence of the medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes (International Knee Documentation Committee Subjective Knee Form [IKDC], Tegner Activity Scale, Lysholm Score, manual stability testing, side-to-side difference of anterior tibial translation based on stress radiographs) and survivorship (failure rate, Kaplan-Meier analysis) after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction by a modified transtibial technique 2 with hamstring tendon autograft was investigated in 232 patients. After a minimum of 10 years of follow-up, no differences in patient-reported outcomes (subjective IKDC, Tegner activity scale, Lysholm score), manual stability testing, or anterior tibial translation measured on lateral stress radiographs could be observed between patients with a medial PTS 5.6 versus >5.6 or a lateral PTS 3.8 versus >3.8 .…”