The Impact of Tibial Slope on Anterior Cruciate Ligament Reconstruction Outcomes – University Hospital Study

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Anterior cruciate ligament (ACL) injuries are common knee injuries that often require surgical reconstruction to restore knee function and stability. Despite advances in surgical techniques, the failure rate for ACL reconstruction remains approximately 15%, emphasizing the need to understand factors contributing to suboptimal outcomes. One factor that has garnered attention is the tibial slope, particularly the posterior tibial slope (PTS), which may influence ACL injury and graft failure. Biomechanical studies suggest that an increased PTS can elevate anterior tibial translation, potentially increasing stress on the ACL and raising the risk of both primary ACL injury and graft failure. However, the clinical significance of tibial slope in ACL reconstruction outcomes remains debated. This retrospective study investigates whether an increased PTS is associated with a higher likelihood of revision surgery or poor surgical outcomes. A total of 152 patients who underwent primary ACL reconstruction or revision surgery between 2018 and 2022 with at least two years of follow-up were included. Tibial slope measurements were obtained from lateral tibial radiographs, and patients were categorized into three groups based on post-surgical outcomes: Group A (successful return to prior sport levels), Group B (stable knee without return to sport), and Group C (requiring revision surgery). The Mann-Whitney U test was used to compare tibial slope measurements across groups. No significant differences were found in tibial slope between the groups (p > 0.05). Group A had a median tibial slope of 6.08°, Group B had 6.68°, and Group C had 5.85°. These findings suggest that tibial slope may not be a major factor influencing ACL reconstruction success or failure. Other factors, including surgical technique, rehabilitation, and patient-specific characteristics, may play more significant roles. Further research is needed to explore the relationship between tibial slope and ACL ...