{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:42:14Z","timestamp":1792579334275,"version":"4.5.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Increased posterior tibial slope (PTS) has been associated with higher revision rates after anterior cruciate ligament reconstruction (ACLR). Whether the addition of lateral extra-articular tenodesis (LET) mitigates the risk associated with increased PTS is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine the prevalence of increased PTS (\u226512\u00b0) in a young high-risk primary ACLR population and evaluate whether LET is associated with lower revision rates in patients with increased PTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included patients aged \u226425 years undergoing primary ACLR across 3 high-volume centers with \u22652 years between surgery and data collection. PTS was measured on lateral radiographs for medial and lateral plateaus. Primary analyses consisted of 4 prespecified multivariable logistic regression models with different PTS operationalizations as continuous predictors per 1\u00b0 increase (medial PTS, lateral PTS, the maximum [PTSmax], and the lateral-medial difference), adjusted for patient and surgical covariates including graft type, with surgical center as a fixed effect. Secondary analyses used PTS dichotomized at 12\u00b0; revision rates were compared between isolated ACLR and ACLR with LET, with the treatment effect quantified as absolute risk reduction and number needed to treat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 780 patients were included; 84 (10.8%) underwent revision ACLR. Increased PTS (\u226512\u00b0) was present in 28.2% of patients and more common in those requiring revision (38.6% vs 27.0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03). In patients with PTSmax \u226512\u00b0, revision occurred in 21.0% without LET and 9.2% with LET (absolute risk reduction, 11.8% [95% CI, 2.3%-21.3%]; number needed to treat, 9); in patients with PTSmax &lt;12\u00b0, revision occurred in 13.2% without LET and 5.4% with LET (absolute risk reduction, 7.8% [95% CI, 3.0%-12.6%]; number needed to treat, 13). In the 4 prespecified multivariable models with PTS as a continuous predictor, LET was independently associated with substantially lower odds of revision ACLR (odds ratio [OR], 0.37; 95% CI, 0.22-0.62;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Lateral PTS (OR, 1.09 per 1\u00b0 increase; 95% CI, 1.00-1.18;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04) and PTSmax (OR, 1.09; 95% CI, 1.00-1.19;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04) were independently associated with revision ACLR. The lateral-medial PTS difference was not associated with revision ACLR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In a young high-risk primary ACLR population, increased PTS was present in nearly 30% of patients. LET was associated with a lower risk of revision irrespective of PTS, while increased PTS was independently associated with revision ACLR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465261473931","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:28:18Z","timestamp":1787200098000},"page":"2936-2945","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased Posterior Tibial Slope and Lateral Extra-articular Tenodesis Are Independently Associated With Revision ACL Reconstruction in a Young High-Risk Population"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3157-3077","authenticated-orcid":false,"given":"Wybren A.","family":"van der Wal","sequence":"first","affiliation":[{"name":"Sports Valley, Department of Orthopedic Surgery, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom M.","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, UMC Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2571-3551","authenticated-orcid":false,"given":"Lamba","family":"Tamana","sequence":"additional","affiliation":[{"name":"Bergman Clinics BV, Naarden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tsoulgkounidis","sequence":"additional","affiliation":[{"name":"Sports Valley, Department of Orthopedic Surgery, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9977-5702","authenticated-orcid":false,"given":"Jorick T.","family":"Veraart","sequence":"additional","affiliation":[{"name":"Sports Valley, Department of Orthopedic Surgery, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy A.G.","family":"Hoogeslag","sequence":"additional","affiliation":[{"name":"Centre for Orthopedic Surgery OCON, Hengelo, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk","family":"van der Hoeven","sequence":"additional","affiliation":[{"name":"Bergman Clinics BV, Naarden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yde","family":"Engelsma","sequence":"additional","affiliation":[{"name":"Bergman Clinics BV, Naarden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roel J.H.","family":"Custers","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.F.","family":"Saris","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"},{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"1","key":"e_1_3_3_2_2","first-page":"14","article-title":"Femoral insertion of the ACL: radiographic quadrant method","volume":"10","author":"Bernard M","year":"1997","unstructured":"Bernard M, Hertel P, Hornung H, Cierpinski T. 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