Effect of tibial slope on the stability of the anterior cruciate ligament–deficient knee

PURPOSE: We aimed to quantify the effect of changes in tibial slope on the magnitude of anterior tibial translation (ATT) in the anterior cruciate ligament (ACL)-deficient knee during the Lachman and mechanized pivot shift tests. We hypothesized that increased posterior tibial slope would increase the amount of ATT of an ACL-deficient knee, while leveling the slope of the tibial plateau would decrease the amount of ATT. METHODS: Lachman and mechanized pivot shift tests were performed on hip-to-toe cadaveric specimens, and ATT of the lateral and the medial compartments was measured using navigation (n = 11). The ACL was then sectioned. Stability testing was repeated, and ATT was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5 or -5° of tibial slope variation after which stability testing was repeated (n = 10). RESULTS: Sectioning the ACL resulted in a significant increase in ATT in both the Lachman and mechanized pivot shift tests (P < 0.05). Increasing or decreasing the slope of the tibial plateau had no effect on ATT during the Lachman test (n.s.). During the mechanized pivot shift tests, a 5° increase in posterior slope resulted in a significant increase in ATT compared to the native knee (P < 0.05), while a 5° decrease in slope reduced ATT to a level similar to that of the intact knee. CONCLUSIONS: Tibial slope changes did not affect the magnitude of translation during a Lachman test. However, large changes in tibial slope variation affected the magnitude of the pivot shift.