Posterior tibial slope in the Emirati population: The slope is over 12 degrees

Posterior tibial slope (PTS) has been reported to be an important risk factor for anterior cruciate ligament (ACL) reconstruction (ACLR) failure. PTS varies between populations, and a mean value in the Emirati population has not been described. To evaluate PTS and to improve clinical decision-making regarding surgical thresholds for slope correcting osteotomy, a mean value for the Emirati population needs to be defined.

This was an institutional review board-approved retrospective study of 213 consecutive Emirati patients with knee complaints visiting a single orthopedic center in 2025. Inclusion criteria were patients >18 years of age visiting the center for the first time with no previous surgery or fracture in the affected knee. Medial and lateral PTS were measured on long weight-bearing lateral tibial radiographs using the proximal and long anatomical tibial axis and mechanical tibial axis.

A total of 213 patients, 73 women and 140 men, were evaluated with a mean age of 46.0 years. The mean medial PTS was 12.8° ± 2.9° (range: 3.7-19.7°), and the mean lateral PTS was 11.9° ± 3.2° (range: 3.9-20.1°) using the proximal tibial axis. Using the long anatomical tibial axis, the mean medial PTS was 14.7° ± 3.3° (range: 4.8-25.5°), and the mean lateral PTS was 13.8° ± 3.7° (range: 5.1-24.8°). Using the mechanical tibial axis, the mean medial PTS was 12.7° ± 3.1° (range: 2.7-19.7°) and the mean lateral PTS was 12.2° ± 3.1° (range: 3.8-20.1°). Sex did not influence the PTS value (p > 0.05).

In this Emirati population, the mean medial PTS was 12.7-14.7° and the mean lateral PTS was 11.9-13.8° for the differing measurement techniques. These values are higher than other reported populations and can be used as a reference when evaluating knee injuries and contribute to surgical decision-making in ACL-deficient knees.