Increased Medial Posterior Tibial Slope Is Associated With Worse Patient‐Reported Outcomes After Bicruciate Ligament Reconstruction

Purpose To evaluate the influence of medial and lateral posterior tibial slopes (MPTS and LPTS) on graft survival and patient‐reported outcomes (PROs) in patients undergoing bicruciate ligament reconstruction for multiligament knee injuries. Methods This retrospective study included patients who underwent bicruciate ligament reconstruction between January 2010 and December 2022. Eligible patients were ≥20 years old and had a minimum of 2 years of clinical follow‐up, whereas those with pre‐existing disability, concomitant tibial plateau, distal femoral, or patellar fractures, or knee dislocation grade V or VI at the time of injury were excluded. MPTS and LPTS were measured on magnetic resonance imaging, and patients were stratified by previously reported slope thresholds (MPTS > 5.6°, LPTS > 3.8° or >7.4°). Graft failure and PROs, including International Knee Documentation Committee score, Tegner activity scale, Lysholm score, and visual analog scale were recorded and analyzed. Results Of the 77 patients who underwent bicruciate reconstruction, 50 met the inclusion criteria and were analyzed. The mean follow‐up was 8.8 ± 7.7 years. Graft failure occurred in 8 patients (16.0%), including 4 anterior cruciate ligament retears, 2 posterior cruciate ligament retears, and 2 cases of graft laxity. No significant differences in graft failure or PROs were observed between groups stratified by MPTS or LPTS thresholds. However, MPTS showed a significant negative correlation with International Knee Documentation Committee ( r s = −0.386, P = .006), Lysholm ( r s = −0.290, P = .041), and Tegner activity scores ( r s = −0.282, P = .047), indicating worse functional outcomes with higher MPTS. No significant correlations were found between LPTS and any PROs. Conclusions Graft failure rates did not differ according to MPTS or LPTS. However, a higher MPTS was associated with lower International Knee Documentation Committee, Lysholm, and Tegner activity scores in linear regression analyses, indicating poorer functional outcomes following bicruciate ligament reconstruction. Level of Evidence Level IV, retrospective case series.