Age Sharply Lowers Absolute ACL Graft Rerupture Risk From Steep Tibial Slope

A retrospective cohort study of 581 patients undergoing primary ACL reconstruction with hamstring autografts found that posterior tibial slope (PTS) was independently associated with graft rerupture, while increasing age was independently protective, with no significant interaction between the two factors. The study reported that for a PTS of 15 degrees, predicted rerupture probability was 36.6% at age 18 versus 3.9% at age 45, and estimated that risk fell below 10% at approximately age 27 for a 12-degree slope and age 35 for a 15-degree slope. The authors concluded that age modulates the absolute, but not relative, risk from elevated PTS after ACL reconstruction.

Most relevant for: Younger patients with elevated posterior tibial slope undergoing ACL reconstruction, particularly in preoperative risk stratification discussions.

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