ArticleBMC musculoskeletal disorders2025
Increased lateral, but not medial, posterior tibial slope is associated with early graft failure following anterior cruciate ligament reconstruction.
Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Predicting risk of unplanned subsequent knee surgery following ACL reconstruction.BMC musculoskeletal disorders · 2026Article
- Longitudinal Changes and Prognostic Factors for Static Anterior Tibial Translation After Anatomic Anterior Cruciate Ligament Reconstruction.Orthopaedic journal of sports medicine · 2026Article
- Non-Contact, Mechanical Fatigue-Related ACL Injury Prevention Through Extracellular Matrix Crosslink Preservation: A Narrative Review.Journal of functional morphology and kinesiology · 2026Review
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6 authors.
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Abstract
BACKGROUND AND STUDY
aimExcessive posterior tibial slope (PTS) has been identified as a biomechanical factor contributing to the risk of anterior cruciate ligament (ACL) injuries and graft failures. Notably, medial and lateral PTS (MPTS and LPTS) may have distinct influences on these outcomes. This study aims to investigate the impact of MPTS and LPTS on the likelihood of ACL graft failure. PATIENTS AND
methodsThis retrospective study included 43 patients who underwent revision ACL reconstruction between 2011 and 2018 due to graft failure within two years of primary surgery. These patients were matched with a control group of 43 individuals who underwent ACL reconstruction without graft failure. Medial and lateral posterior tibial slope (MPTS and LPTS) were measured using the Hudek method on magnetic resonance imaging (MRI) and compared between the two groups. Clinical evaluation included the preoperative Tegner activity score, pivot-shift test, Lachman test, and Lysholm score, as well as the postoperative pivot-shift test, Lachman test, and Lysholm score assessed at the two-year follow-up.
resultsThe mean LPTS was significantly higher in the ACL revision reconstruction (RR) group compared to the primary reconstruction (PR) group (6.8 ± 3.6 vs. 3.2 ± 5.7, p < 0.05). However, no significant difference was observed in MPTS between the groups (3.0 ± 3.5 in the RR group vs. 2.4 ± 4.5 in the PR group, p = 0.56). Receiver operating characteristic (ROC) analysis determined an LPTS cut-off value of 6.0°. The Lachman test was positive in all patients preoperatively and became negative postoperatively in both groups. There was a significant improvement in pivot-shift grades from preoperative to postoperative evaluations in both groups. Both groups demonstrated significant improvement in Lysholm scores from preoperative to postoperative assessments, with no significant differences between the groups in either preoperative or postoperative scores.
conclusionAn increased LPTS (> 6.0°) is a significant risk factor for early ACL graft failure. Therefore, routine preoperative measurement of LPTS is recommended to identify patients at higher risk.
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