Work

High posterior tibial slope increases graft failure risk but does not impair functional outcomes after primary ACL reconstruction

Year: 2025

Type: article

Abstract: PURPOSE: Posterior tibial slope (PTS) has been implicated in anterior cruciate ligament (ACL) graft failure, but its relationship to objective stability and patient-reported outcomes (PROs) after primary ACL reconstruction (ACLR) remains unclear. The study evaluated whether higher PTS is associated with laximetry, graft survival, and PROs after hamstring autograft ACLR. METHODS: Patients undergoing primary ACLR with semitendinosus autograft between January 2019 and January 2022 by a single surgeon were retrospectively reviewed. Radiographic PTS was measured on long-leg lateral radiographs, and anterior tibial translation (ATT) was assessed using Telos stress radiographs at baseline and follow-up. PROs included KOOS, IKDC (clinical grade), ACL-RSI, and Tegner. Patients were grouped as PTS <12° versus ≥12°. Graft failure was defined as Telos side-to-side difference (SSD) > 5 mm. Kaplan-Meier analysis estimated graft survival. RESULTS: We included 293 patients (mean age, 28.7 ± 4.5 years; 59.6% male). KOOS Pain, QOL and global scores improved significantly from baseline, as did ACL-RSI scores (all p < 0.05). Functional outcomes at 2 years did not differ significantly between PTS groups. However, high PTS was associated with significantly greater side-to-side ATT at 1 and 2 years (p = 0.002 and <0.001, respectively) and a higher graft failure rate (64.7% vs. 33.8%; OR, 3.2; p < 0.001). Kaplan-Meier analysis showed shorter graft survival in the high PTS group (23.1 vs. 32.8 months; p < 0.001). CONCLUSION: PTS ≥ 12° is associated with inferior objective stability and increased radiographic graft failure after primary ACLR, whereas 2-year PROs are comparable across slope groups. Tibial slope is a practical preoperative risk-stratification factor that should inform counselling and follow-up intensity. LEVEL OF EVIDENCE: Level III.

Source: Knee Surgery Sports Traumatology Arthroscopy

DOI: 10.1002/ksa.70154

Authors: Paul Souvik, Maher Ghandour, Ernest Siret, Fabio Sammartino, Piercecchi Antoine, Matthieu Ollivier