Posterior Tibial Slope: Current Understanding and Evidence

Description

The presentation, led by Bertrand Cottet-Sonnery from Lyon, centers on the topic of posterior tibial slope and its implications in ACL (anterior cruciate ligament) reconstruction and injury prevention. Bertrand shares his insights from historical perspectives on surgical techniques, particularly the anterior closing wedge osteotomy, which originated from veterinary practices for ACL injuries in small animals. He highlights notable studies, including one from Bruce Reider in 2019, demonstrating the relationship between tibial slope osteotomy and decreased ACL force, emphasizing that higher tibial slope angles correlate with increased injury risks in ACL reconstructions.



Throughout the presentation, Bertrand outlines key factors contributing to ACL graft failures, distinguishing between technical errors from malpositioning of tunnels and intrinsic factors, like anatomical features of the knee, including the tibial slope. Data indicates that a significant majority of patients with ACL ruptures have either a narrow intercondylar notch or an increased posterior tibial slope.



He provides clinical evidence from a longitudinal study indicating critical thresholds for slope angles that elevate the risk for ACL re-injuries and stresses the importance of accurately measuring posterior tibial slope using MRI or X-ray imaging.



The presentation transitions to surgical techniques focusing on the goal of maintaining a tibial slope of less than 9 degrees during ACL revisions. Detailed steps are provided, including tibial-slope osteotomy procedures that preserve the tibial tuberosity to maintain the integrity of the extensor apparatus.



Bertrand then presents a compelling case study of a professional rugby player who faced multiple ACL ruptures, illustrating how adjustments in surgical technique and postoperative management, including a brace protocol, contributed to successful outcomes. He advocates for adopting anterior closing wedge osteotomies in ACL revision surgeries with heightened tibial slope, citing promising clinical results while acknowledging the need for further research.



The presentation concludes with Bertrand expressing gratitude and the hope for enhanced collaboration and discoveries in the field.

Specialties