Posterior tibial slope is measured on a true lateral knee radiograph, as the angle between a line along the medial tibial plateau and a line perpendicular to the tibial shaft axis. A slope of about 12 degrees or more is widely regarded as raised. The measurement takes a minute, varies with technique, and is easy to forget when the MRI is the focus of the work-up.
- Get a true lateral knee radiograph before ACL reconstruction.
- Use a consistent method, with a long enough view of the tibial shaft.
- Record the value in the notes and the operation note.
- Flag steep slopes in young patients for senior discussion.
Why it matters
Slope is one of the few rerupture risk factors a surgeon can measure before operating.
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