编委评述：膝关节韧带手术中胫骨后倾角的管理：为何如此关注
简介
这篇述评指出，在ACL和PCL重建术后移植物失败率仍较高的情况下，后胫骨后倾角（PTS）已成为影响移植物生物力学和临床预后的关键可调控因素。增加PTS会加重前向胫骨平移，增加ACL移植物应力，而减小PTS则可能使PCL重建过载；作者强调应使用站立位单腿全长胫骨侧位X线片测量内侧PTS，并认为优化PTS是降低复杂膝关节韧带手术移植物失败率的重要机会。
英文摘要
Graft failure after knee ligament reconstruction persists despite decades of technical refinement in anterior cruciate ligament and posterior cruciate ligament surgery. Recently, attention has shifted towards posterior tibial slope (PTS) as a key, modifiable driver of graft biomechanics and clinical outcomes. Importantly, multiple authors have reported that increased PTS promotes anterior tibial translation, thus elevating the stress placed upon the anterior cruciate ligament graft while decreased slope may overload posterior cruciate ligament reconstructions. Although multiple imaging modalities exist to measure PTS, recent work has emphasized the importance of using the medial tibial slope rather than the lateral slope, and to ideally perform the slope measurement on a full-length, standing mono-pedal lateral tibial radiograph with at least 15 cm of tibial bone length. Currently, there is no standard "cut off" values for PTS, in particular for bicruciate ligament reconstructions. Optimization of PTS and its downstream effects on both anterior and posterior tibial translation may represent one of the most impactful opportunities to improve patient outcomes and reduce graft failure rates in complex knee ligament surgery.