• Tilman Hees, Jasmin Zielke, and Wolf Petersen.
• Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Straße 27-31, 14193, Berlin, Germany. tilman.hees@gmail.com.
• Arch Orthop Trauma Surg. 2023 Jun 1; 143 (6): 295929642959-2964.

PurposeThe posterior tibial slope (PTS) has different biomechanical effects on the knee. Especially in revision ACL reconstruction, a precise analysis is essential. Therefore, we investigate the influence of the anterior tibial bowing angle on the posterior slope measurement. Our hypothesis of the present study is that the short tibial X-rays underestimate the PTS in cases with increased anterior bowing of the tibia.MethodsThe PTS was measured on 162 true longitudinal radiographs of the complete tibia (lateral mechanic axis). The average age of the patients was 35.7 years (range 19-59 years) and the most common diagnosis was failed anterior cruciate ligament reconstruction. Using this X-ray, the slope on the short axis and the slope on the entire axis were measured. In addition, the angle of the anterior bowing was determined.ResultsThe mean PTS for the lateral mechanic axis of the tibia was 10.6° (± 3.5) in contrast to 11.6° (± 3.5) for the short tibial axis. These two measurements differ significantly. (p  < 0.001). The mean anterior tibial bowing angle on the lateral X-rays of the whole tibia was 2.3° (± 2.0). There is a significant positive, relationship between tibial bowing angle and PTS as referenced by the lateral mechanic axis (Spearman's correlation, r = 0.273 and p < 0.001).ConclusionWith increasing anterior tibial bowing, the posterior tibial slope on the short knee radiograph is underestimated compared to the slope measurement on the lateral mechanic axis.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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