Editorial Commentary: Posterior Tibial Slope-Reducing Osteotomy Should Be Considered in Patients Having Primary Anterior Cruciate Ligament Reconstruction if Posterior Tibial Slope Is Greater Than 12° to 14°.

Increased posterior tibial slope (PTS) has long been known to increase the risk of anterior cruciate ligament (ACL) reconstruction failure in both the primary and revision setting. In cases of failed ACL reconstruction in the setting of high tibial slope, ACL revision plus a slope-correcting tibial deflexion osteotomy is more effective than ACL revision plus a lateral extra-articular procedure such as anterolateral ligament reconstruction or lateral extra-articular tenodesis. Recent research has confirmed that slope-reducing proximal tibial osteotomy improves outcomes in ACL reconstruction patients with elevated PTS, especially in ACL revision cases and in cases with PTS of 12° or greater. Absent slope-correcting osteotomy, patients with PTS of 12° or greater have high rates of failure after hamstring ACL reconstruction and increased rates of failure after bone-patellar tendon-bone reconstruction. PTS reduction should be considered in patients having primary ACL reconstruction if PTS is greater than 12° to 14°.