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28.05.2018 | Arthroscopy and Sports Medicine

Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction

Archives of Orthopaedic and Trauma Surgery
Vera Jaecker, Sabrina Drouven, Jan-Hendrik Naendrup, Ajay C. Kanakamedala, Thomas Pfeiffer, Sven Shafizadeh



To analyze the contribution of increased lateral (LTPS) and medial tibial slopes (MTPS) as independent risk factors of graft failure following anterior cruciate ligament (ACL) reconstruction.

Materials and methods

Fifty-seven patients with graft failure after ACL reconstruction who underwent revision surgery between 2009 and 2014 were enrolled and matched to a control group of 69 patients with primary anatomic successful ACL reconstruction. Patients were matched based on age, sex, date of primary surgery and graft type. LTPS and MTPS were measured on MRI in a blinded fashion. Tibial and femoral tunnel positions were determined on CT scans. Independent t test was used to compare the MTPS and LTPS between subgroups. Risks of graft failure associated with an increasing MTPS and LTPS were analyzed using binary logistic analysis.


The means of LTPS (7.3°) and MTPS (6.7°) in the graft failure group were found to be significantly greater than in the control group (4.6° and 4.1°, respectively; p = < 0.001). Non-anatomic and anatomic tunnel positions were found in 42 cases (73.7%) and 15 cases (26.3%), respectively. There were no significant differences in MTPS or LTPS between patients with anatomic and non-anatomic tunnel positions within the graft failure group. An increase of the MTPS of 1° was associated with an 1.24 times increased likelihood of exhibiting graft failure [95% CI 1.07–1.43] (p = 0.003) and an increase of the LTPS of 1° was associated with an 1.17 times increased likelihood of exhibiting graft failure [95% CI 1.04–1.31] (p = 0.009). The increased risk was most evident in patients with a lateral tibial posterior slope of ≥ 10°.


Increased LTPS and MTPS are independent risk factors for graft failure following ACL reconstruction regardless whether tunnel position is anatomic or non-anatomic. This information may be helpful to clinicians when considering slope correction in selected revision ACL reconstruction procedures.

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