Increasing posterior tibial slope does not raise anterior cruciate ligament strain but decreases tibial rotation ability

Background: It was investigated whether the strain of the anterior cruciate ligament and tibial kinematics are affected by increasing posterior tibial slope. Methods: 9 human cadaveric knee joints were passively moved between full extension and 120 degrees flexion in a motion and loading simulator under various loading conditions and at 0 degrees, 5 degrees, 10 degrees and 15 degrees posterior tibial slope angles. The anterior cruciate ligament strain and the tibial rotation angle were registered. To assess the influence of posterior tibial slope on the anterior cruciate ligament strain at a fixed flexion angle the anterior cruciate ligament strain was recorded at three different flexion angles of 0 degrees, 30 degrees and 90 degrees while continuously increasing the osteotomy angle from 5 degrees to 15 degrees. Findings: The anterior cruciate ligament strain was either not affected by the posterior tibial slope angle or, in some load cases, was decreased for increasing posterior tibial slope (P<0.05). There was a significant decrease of tibial rotation when the posterior tibial slope was increased to 15 degrees for many of the load cases tested (P<0.05). The mean maximum decrease was from 17.4 degrees (SD 5.7 degrees) to 112 degrees (SD 4.7 degrees) observed for flexion-extension motion under 30 N axial load in combination with an internal rotation moment. Interpretation: The hypothesis that increasing posterior tibial slope results in higher anterior cruciate ligament strain was not confirmed. However, knee kinematics were affected in terms of a reduced tibial rotation. From a biomechanical point of view the data do not support the efficacy of sagittal osteotomies as performed to stabilize anterior cruciate ligament deficient knees. (c) 2013 Elsevier Ltd. All rights reserved.