The paper addresses an important evolution in knee osteotomies — specifically the surgical correction of posterior tibial slope (PTS) through infra-tubercle level osteotomies. A steep PTS is increasingly recognised as a modifiable anatomical factor that contributes to graft failures in anterior cruciate ligament (ACL) surgery and knee instability. This editorial argues for the infra-tubercle approach as the preferred level for slope-changing osteotomies.
Scope & key points of the editorial
- The authors highlight biomechanical evidence that a steeper posterior tibial slope correlates with increased anterior tibial translation and higher ACL graft strain, particularly in pivoting sports. (ESSKA Journals)
- They propose the “infra-tubercle” osteotomy as advantageous: below the tibial tubercle, allows for better hinge control, maintains extensor mechanism integrity, and may reduce patellar height alteration.
- The editorial reviews evidence showing successful outcomes in slope-reducing osteotomies (e.g., reduction of graft re-tear risk) and suggests that surgical planning for ACL revision or instability cases should routinely consider slope correction. (PubMed)
Clinical messages for surgeons
- In revision ACL or high-instability cases, assess posterior tibial slope and consider whether correction might improve stability outcomes.
- When slope reduction is indicated, infra-tubercle osteotomy may offer technical benefits in hinge control and alignment preservation.
- Surgical planning should integrate slope correction with the rest of the knee alignment strategy (coronal, sagittal, rotational) rather than treating it as a standalone procedure.
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/39829051/
- https://esskajournals.onlinelibrary.wiley.com/doi/full/10.1002/ksa.12589
- https://researchportal.lih.lu/en/publications/slope-changing-osteotomies-in-the-knee-time-to-go-infra/
