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Review
. 2023 Jul 20;57(9):1376-1386.
doi: 10.1007/s43465-023-00947-x. eCollection 2023 Sep.

Posterior Tibial Slope in Anterior Cruciate Ligament Surgery: A Systematic Review

Vipul Mandalia  1 , Morgan Bayley  2 , Nivraj Bhamber  1 , Simon Middleton  1 , James Houston  1
Affiliations
Review

Posterior Tibial Slope in Anterior Cruciate Ligament Surgery: A Systematic Review

Vipul Mandalia et al. Indian J Orthop. .

Abstract

Background: While the literature suggests a correlation between posterior tibial slope and sagittal stability of the knee, there is a lack of consensus relating to how to measure the slope, what a normal slope value would be, and which critical values should guide extra surgical treatment. We performed a systematic literature review looking at the posterior tibial slope and cruciate ligament surgery. Our aims were to define a gold standard measurement technique of posterior tibial slope, as well as determining its normal range and the important values for consideration of adjuncts during cruciate ligament surgery.

Methods: Electronic searches of MEDLINE (PubMed), CINAHL, Cochrane, Embase, ScienceDirect, and NICE in June 2020 were completed. Inclusion criteria were original studies in peer-reviewed English language journals. A quality assessment of included studies was completed using the Methodological Index for Non-Randomized Studies (MINORS) Criteria.

Results: Two-hundred and twenty-one papers were identified; following exclusions 34 papers were included for data collection. The mean MINORS score was 13.8 for non-comparative studies and 20.4 for comparative studies, both indicating fair to good quality studies. A large variation in the posterior tibial slope measurement technique was identified, resulting in a wide range of values reported. A significant variation in slope value also existed between different races, ages and genders.

Conclusion: Cautiously, the authors suggest a normal range of 6-12º, using the proximal tibial axis at 5 and 15 cms below the joint. We suggest 12º as a cut-off value for slope-reducing osteotomy as an adjunct to revision ligament reconstruction.

Keywords: ACL; Knee; Ligament; Tibia.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA Flow diagram of studies’ screening and selection
Fig. 2
Fig. 2
Measurement of posterior tibial slope using mechanical axis on a lateral radiograph
Fig. 3
Fig. 3
Different tibial axes, MA Mechanical Axis, ATC Anterior Tibial Axis, PTC Posterior Tibial Axis, PTA Proximal Tibial Axis, CTA Central Tibial Axis and FSA Fibular Shaft Axis
Fig. 4
Fig. 4
Hudek’s technique for axis calculation with medial and lateral PTS measurement
Fig. 5
Fig. 5
Sagittal MRI comparing Hudek’s technique and a method using two landmarks at approximately 5 and 15 cm distal to the joint to calculate the proximal tibial axis
See this image and copyright information in PMC

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