Editorial Commentary: Patients With Anterior Cruciate Ligament Tears and High Posterior Tibial Slope Show Increased Risk of Failure and Meniscal Root Tears.

Abstract

Excessive posterior tibial slope (PTS) has been implicated in increasing the risk of anterior cruciate ligament (ACL) graft failure. Although the exact threshold for excess PTS remains unclear, a PTS >12° leads to a 5-fold increase in the risk of primary ACL reconstruction failure and as high as an 18-fold increase for revision ACL reconstruction. In addition, recent studies have indicated that steep medial tibial slope, lateral tibial slope, and meniscal slopes are associated with an increased incidence of posterior horn of the meniscus and root lesions, with a large percentage of these lesions missed on magnetic resonance imaging. Thus, careful evaluation of meniscal lesions, including ramp lesions, should be performed when PTS is high. Routine evaluation of the PTS should be done to address these specific concerns and to consider additional procedures for the anterolateral complex or an anterior closing wedge proximal tibial osteotomy in patients with a high PTS.