KSSTA - 2026-09-16 - Journal Article
Increased medial posterior tibial slope is associated with greater postoperative anterior tibial translation over time after anterior cruciate ligament reconstruction.
Paul S, Ghandour M, Jacquet C, Kley K, Sammartino F, Ollivier M
Topics
Key Takeaway
Medial posterior tibial slope independently predicts increasing ATT side-to-side difference after ACLR, with a correlation rising from r=0.2 at 1 year to r=0.3 at 2 years, while LET reduces 2-year ATT SSD by 1.2 mm (6.1 vs. 7.3 mm).
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Summary
This study examined whether medial PTS predicts longitudinal postoperative ATT following primary semitendinosus autograft ACLR in 319 patients, using Telos stress radiography at four time points. Medial PTS was a weak but independent predictor of ATT SSD at 1 and 2 years on multivariable regression (p<0.01), with the correlation strengthening over time (r=0.2 to r=0.3). LET attenuated laxity progression (2-year ATT SSD 6.1 vs. 7.3 mm, p=0.009), while older age and medial cartilage lesions were associated with greater postoperative laxity.
Key Limitation
The correlation between PTS and ATT SSD, while statistically significant, is weak (r=0.3 at 2 years), limiting the ability to define a clinically actionable PTS threshold that reliably predicts graft failure or functional instability.
Original Abstract
PURPOSE
To investigate the longitudinal relationship between medial posterior tibial slope (PTS) and postoperative anterior tibial translation (ATT) following anterior cruciate ligament reconstruction (ACLR), and to determine whether age, cartilage lesions and the use of lateral extra-articular tenodesis (LET) modify this relationship.
METHODS
We retrospectively analysed 319 patients who underwent primary ACLR with a semitendinosus autograft. Medial PTS was measured on long lateral radiographs (circle method) at 2 months and at final follow-up. ATT was assessed by Telos™ stress radiography in both knees preoperatively and at 2 months, 1 year and 2 years. Three measures were defined: the absolute ATT of the operated knee; the ATT side-to-side difference (ATT SSD; operated minus contralateral knee); and the change in this difference from the preoperative baseline (ΔATT SSD). Associations were tested with Pearson's/Kendall's correlation, group comparisons and multivariable regression; subgroups were defined by age, cartilage status and LET.
RESULTS
The absolute operated-knee ATT was 5.8 ± 3.5 mm preoperatively and 2.9 ± 2.3, 4.9 ± 2.8 and 6.8 ± 4.0 mm at 2 months, 1 year and 2 years, respectively. Medial PTS correlated positively but weakly with the ATT SSD at 1 year (r = 0.2, p = 0.001) and 2 years (r = 0.3, p < 0.001); at 2 months, the correlation was negative and non-significant (r = -0.5, p = 0.3). Medial PTS at 2 months and at final follow-up were independent predictors of the ATT SSD on multivariable regression (p < 0.01). Older age (r = 0.15, p = 0.009) and medial cartilage lesions (p = 0.008) were associated with greater postoperative laxity, whereas LET was associated with a lower 2-year ATT SSD (6.1 vs. 7.3 mm; p = 0.009). Meniscal and lateral cartilage lesions showed no significant association.
CONCLUSION
Steeper medial PTS is associated with a progressive, though weak, increase in the ATT SSD following ACLR. LET attenuates this effect, whereas older age and medial cartilage lesions are associated with greater early laxity.
LEVEL OF EVIDENCE
Level III.