Editorial Commentary: Measuring Posterior Tibial Slope: You Don't Always Have to Obtain a Full-Length Tibial...

The posterior tibial slope, used to define the angulation of the tibial plateau relative to the tibial shaft, is an important radiographic measurement that has gained significant interest recently. Increasing biomechanical and clinical literature has demonstrated the importance of evaluating posterior tibial slope because of its impact on knee kinematics. Although the risk of anterior cruciate ligament injury and graft rupture is multifactorial, studies have demonstrated that increased posterior tibial slope is likely a contributing factor. Numerous measurement techniques have been proposed for the evaluation of posterior tibial slope, but there remains a lack of consensus on how best to quantify sagittal alignment for the failed anterior cruciate ligament reconstruction. Consistent and precise assessment of the anatomic axis is paramount to guide clinical decision making, particularly when considering a deflexion, slope-reducing tibial osteotomy. Regardless of your technique, hear our humble plea: you don't always have to obtain a full-length tibial radiograph when measuring posterior tibial slope, but you should definitely include at least 15 cm of proximal tibia on a lateral knee radiograph. The rest is up to you!