Tibial Sagittal Slope in Anterior Cruciate Ligament Injury and Treatment. Issue 21 (1st November 2021)

• Record Type: Journal Article
• Authors: Alaia, Michael J.; Kaplan, Daniel J.; Mannino, Brian J.; Strauss, Eric J.
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 29:Issue 21(2021)
• Publication Date: 2021-11-01
• Subjects: Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-21-00143
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Although anterior cruciate ligament reconstruction (ACLR) is a generally successful procedure, failure is still relatively common. An increased posterior tibial slope (PTS) has been shown to increase the anterior position of the tibia relative to the femur at rest and under load in biomechanical studies. Increased PTS has also been shown to increase forces on the native and reconstructed ACL. Clinical studies have demonstrated elevated PTS in patients with failed ACLR and multiple failed ACLR, compared with control subjects. Anterior closing-wedge osteotomies have been shown to decrease PTS and may be indicated in patients who have failed ACLR with a PTS of ≥12°. Available clinical data suggest that the procedure is safe and effective, although evidence is limited to case series. This article presents the relevant biomechanics, clinical observational data on the effects of increased PTS, and an algorithm for evaluating and treating patients with a steep PTS.