Editorial Commentary: When Performing Proximal Tibial Slope Decreasing Osteotomies in Patients Undergoing Primary or Revision Anterior Cruciate Ligament Reconstruction, Surgeons Must Be Cautious to Avoid Overcorrection of the Posterior Tibial Slope: Teeter-Totter Tibial Translation.

An excessive or large proximal tibial posterior slope is directly correlated with the risk of knee joint injury. This includes anterior cruciate ligament (ACL) graft reconstruction failure and meniscal tear. Correction of the excessive posterior slope seems prudent in patients whose prior surgical procedures have not succeeded in restoring normal knee stability including anterior tibial translation. Such an approach has been presented through techniques involving tibial osteotomy. By decreasing the tibial slope, there will be a decrease in the rate of ACL graft failure. When one is performing a corrective osteotomy, the correction should be neither too little nor too much. Too little a correction will not sufficiently alter the mechanics, resulting in a limited effect. Too great a change will produce negative static anterior tibial translation. Moreover, recent research has shown that after slope-correcting osteotomy, achieving the target slope occurs in fewer than 50% of cases. Surgeons must be cautious to avoid overcorrection of the posterior tibial slope.