AJSM June 2026 Podcast: Association Between Posterior Tibial Slope and Graft Survival in High-Risk Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis
Posterior tibial slope (PTS) is a
well-established anatomic risk factor for anterior cruciate
ligament (ACL) graft failure. Lateral extra-articular tenodesis
(LET) is increasingly used as an adjunctive procedure in high-risk
patients to reduce rerupture rates; however, how its protective
effect varies across the continuum of slope values remains
insufficiently characterized.
In conclusion, PTS was independently
associated with graft failure in both groups. Although LET was
associated with lower failure probabilities within a moderate slope
range, increasing PTS values were linked to a progressively higher
risk of reruptures in both groups. The association between a
steeper slope and failure observed in the ACLR with LET group
suggests that an elevated PTS may attenuate the relative protective
effect of LET.
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