ArticleArchives of orthopaedic and trauma surgery2025
Individualized indication for slope changing osteotomy in ACL insufficiency: the Avalanche Concept.
Article in Archives of orthopaedic and trauma surgery, 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Management of increased posterior tibial slope in ACL deficiency: A narrative review and recommendation of the Osteotomy Committee of the German Knee Society.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Review
- Anterior open wedge high tibial osteotomy for slope correction as a successful method in PCL insufficiency-Radiological and clinical results of a cohort study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Anterior tibial translation versus rotational instability in ACL reconstruction: Defining the problem before choosing the procedure.Journal of experimental orthopaedics · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The management of increased posterior tibial slope (PTS) in anterior cruciate ligament (ACL) injuries and insufficiencies and especially the indication for slope changing osteotomies has evolved to a highly discussed topic. The majority of available studies refer to cut-off values for the PTS and the number of previous ACL reconstructions in their indications. However, ACL injuries are a complex multifactorial problem, and available recommendations mainly ignore these highly individual factors, in their presence, and also in their complexity. Actually, many of the known risk factors for ACL insufficiency are also directly or indirectly associated with PTS. Therefore, the purpose of this paper is to propose a whole new way of thinking about complex ACL treatment strategies by integrating the PTS in a comprehensive approach of individual risk assessment and decision making. It is inspired by an established risk stratification system in a completely different but also very comparable field: avalanches. It is ultimately based on the thorough analysis of individual risk factors and accompanying circumstances on the one hand, and the standardized measured PTS on the other hand. These then define a point on a heat map (in a coordinate system) which, through the underlying colour, reflects the strength of the recommendation for a slope correction. This is to introduce The Avalanche Concept.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.