Slope reducing osteotomy: The emerging gap between indication, safety and proportionality

Slope-reducing osteotomy (SRO) has emerged as a valuable risk-mitigation tool in the management of anterior cruciate ligament (ACL) injuries, particularly in high-risk patients and in revision settings. However, its rapid adoption has outpaced the evidence defining when, how and in whom it should be performed, raising important questions regarding proportionality, technical demand and patient selection. This editorial argues that SRO should be guided by integrated, individualised risk stratification rather than isolated numerical thresholds, and that clinical judgement and surgical experience remain the essential safeguards for its safe and effective application.