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<p>The correction of an increased posterior tibial slope (PTS) is gaining in importance in the treatment of anterior cruciate ligament (ACL) insufficiency, particularly in the revision setting. A&#xa0;steep PTS increases the load on the native or reconstructed ACL due to enhanced anteriorly directed forces. However, the indication for a&#xa0;PTS-reducing osteotomy is complex and influenced by numerous patient-specific factors. Based on biomechanical findings and clinical understanding of the challenges associated with an increased PTS, the Avalanche concept is introduced as a&#xa0;dynamic decision-making model. This model integrates the degree of PTS with individual risk factors, thereby enabling patient-specific treatment planning. PTS-reducing osteotomies have demonstrated favorable clinical outcomes in the literature, particularly in revision procedures involving high-grade instability, multiple prior surgeries, or pronounced anterior tibial subluxation. The infratuberosity anterior closing-wedge osteotomy is considered a&#xa0;technically safe and effective technique. In this article, the principles of current indications and the surgical technique in the context of existing ACL insufficiency are summarized.</p>

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Slopekorrektur bei Insuffizienz des vorderen Kreuzbandes

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Philipp Mayer,
  • Martin Häner

摘要

The correction of an increased posterior tibial slope (PTS) is gaining in importance in the treatment of anterior cruciate ligament (ACL) insufficiency, particularly in the revision setting. A steep PTS increases the load on the native or reconstructed ACL due to enhanced anteriorly directed forces. However, the indication for a PTS-reducing osteotomy is complex and influenced by numerous patient-specific factors. Based on biomechanical findings and clinical understanding of the challenges associated with an increased PTS, the Avalanche concept is introduced as a dynamic decision-making model. This model integrates the degree of PTS with individual risk factors, thereby enabling patient-specific treatment planning. PTS-reducing osteotomies have demonstrated favorable clinical outcomes in the literature, particularly in revision procedures involving high-grade instability, multiple prior surgeries, or pronounced anterior tibial subluxation. The infratuberosity anterior closing-wedge osteotomy is considered a technically safe and effective technique. In this article, the principles of current indications and the surgical technique in the context of existing ACL insufficiency are summarized.