TY - JOUR
T1 - Assessment and surgical correction of posterior tibial slope in revision anterior cruciate ligament surgery
T2 - An international expert Delphi consensus statement
AU - Wackerle, Anja M.
AU - Marcaccio, Stephen
AU - Apseloff, Nicholas
AU - Getgood, Alan
AU - Musahl, Volker
AU - Tapasvi, Sachin
AU - Alaia, Michael J.
AU - Amendola, Annunziato
AU - Becker, Roland
AU - Brown, Charles H.
AU - Chahla, Jorge
AU - Clatworthy, Mark
AU - Dawson, Matthew J.
AU - Dejour, David
AU - Frosch, Karl Heinz
AU - Gelber, Pablo E.
AU - Godshaw, Brian M.
AU - Guenther, Daniel
AU - Heard, S. Mark
AU - van Heerwaarden, Ronald
AU - Hirschmann, Michael T.
AU - Hughes, Jonathan D.
AU - Imhoff, Florian B.
AU - Khakha, Raghbir Singh
AU - Kley, Kristian
AU - LaPrade, Robert F.
AU - Levy, Bruce A.
AU - Lowe, Walter R.
AU - Lustig, Sébastien
AU - Maestu, Rodrigo
AU - Menetrey, Jacques
AU - Neyret, Philippe
AU - Ollivier, Matthieu
AU - Parker, David A.
AU - Petersen, Wolf
AU - Ranawat, Anil S.
AU - Schröter, Steffen
AU - Seil, Romain
AU - Sherman, Seth L.
AU - Słynarski, Konrad
AU - Sonnery-Cottet, Bertrand
AU - Spalding, Tim
AU - Verdonk, René
AU - Vidal, Armando F.
AU - Waterman, Brian R.
AU - Weiler, Andreas
AU - Williams, Andy
AU - Wilson, Adrian
AU - Zaffagnini, Stefano
AU - Posterior Tibial Slope Consensus Group
N1 - Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.
PY - 2025/5/29
Y1 - 2025/5/29
N2 - Purpose: The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR). Methods: This guideline is based on responses from 46 international orthopaedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80 % of survey respondents fully agreed. Results: With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5–7°, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians’ decision-making in revision ACLR management and to focus future areas of required research. Conclusion: The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78 %) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects. Level of Evidence: V, expert opinion.
AB - Purpose: The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR). Methods: This guideline is based on responses from 46 international orthopaedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80 % of survey respondents fully agreed. Results: With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5–7°, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians’ decision-making in revision ACLR management and to focus future areas of required research. Conclusion: The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78 %) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects. Level of Evidence: V, expert opinion.
KW - Anterior cruciate ligament
KW - Consensus
KW - Osteotomy
KW - Posterior tibial slope
UR - http://www.scopus.com/inward/record.url?scp=105008882097&partnerID=8YFLogxK
U2 - 10.1016/j.jisako.2025.100900
DO - 10.1016/j.jisako.2025.100900
M3 - Article
C2 - 40446928
AN - SCOPUS:105008882097
SN - 2059-7754
VL - 13
JO - Journal of ISAKOS
JF - Journal of ISAKOS
M1 - 100900
ER -