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How to Measure Posterior Tibial Slope for Anterior Closing Wedge Osteotomy
Abid M Khan1, Adam V Daniel1, Alexander K Bishop1
1Orlando Health Jewett Orthopedic Institute Orlando Florida U.S.A.
Arthroscopy Techniques
|July 1, 2026
Summary
Accurately measuring posterior tibial slope (PTS) before surgery is crucial for anterior cruciate ligament (ACL) graft success. This study details weight-bearing X-ray methods for precise PTS measurement and surgical planning.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomechanics
Background:
- Elevated posterior tibial slope (PTS) > 12° is a significant risk factor for anterior cruciate ligament (ACL) graft reconstruction failure.
- Reducing PTS is a protective strategy for ACL grafts, achievable via anterior closing-wedge osteotomy.
- Accurate PTS measurement is essential for determining the necessary correction before surgery.
Purpose of the Study:
- To present validated, step-by-step techniques for measuring PTS.
- To demonstrate reproducible methods for measuring anterior tibial translation.
- To detail the use of monopedal, full-length, weight-bearing tibia standing radiographs for these measurements in the context of anterior closing-wedge osteotomy.
Main Methods:
- Utilizing monopedal, full-length, weight-bearing tibia standing radiographs.
- Implementing validated and reproducible step-by-step techniques for PTS measurement.
- Applying precise methods for assessing anterior tibial translation.
Main Results:
- Established gold standard radiographic techniques for PTS measurement.
- Demonstrated reproducible methods for quantifying PTS and anterior tibial translation.
- Provided a framework for accurate pre-operative planning of anterior closing-wedge osteotomy.
Conclusions:
- Accurate measurement of PTS and anterior tibial translation using weight-bearing radiographs is critical for successful ACL graft reconstruction outcomes.
- Validated radiographic techniques ensure precise pre-operative planning for anterior closing-wedge osteotomy.
- Weight-bearing radiographs offer a reliable method for assessing tibial slope and guiding surgical correction to protect ACL grafts.
