Background: The addition of a lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce ACL graft rupture rates. Posterior tibial slope (PTS) and static anterior tibial translation (SATT) are also recognized as risk factors for ACL graft rupture. Purpose/Hypothesis: The purpose was to evaluate the effect of PTS and SATT on graft rupture rates after ACLR using hamstring tendon autografts combined with LET. It was hypothesized that increased PTS and SATT would result in increased ACL graft rupture rates despite the addition of an LET. Study Design: Case-control study; Level of evidence, 3. Methods: This retrospective, single-center, single-surgeon study included patients who underwent primary ACLR with hamstring tendon autografts combined with LET between January 2014 and December 2017. Demographic data were collected, and the association between PTS, SATT, and ACL graft rupture rates was assessed with a minimum follow-up of 6 years. Subgroup analyses were performed using PTS thresholds of 9° and 12°, as well as an SATT threshold of 5 mm. Univariate and multivariate analyses were conducted to identify significant risk factors for ACL graft rupture. Results: Of the 934 ACLR procedures performed, 207 patients met the inclusion criteria. With a 90% response rate, 186 patients who underwent primary ACLR with hamstring tendon autografts and LET were included for analysis. ACL graft rupture rate for patients with a PTS ≥12° (19.4%) was significantly ( P < .001) higher than that for patients with PTS <12° (2.7%). The highest ACL graft rupture rate (26%) was observed in patients with both a PTS ≥12° and an SATT ≥5 mm. Patients with a PTS <9° demonstrated no ACL graft ruptures (0/60). The risk of graft rupture was significantly associated with a PTS ≥12° (OR, 12; 95% CI, 0.1-0.4; P < .001), SATT ≥5 mm (OR, 1.4; 95% CI, 0.2-3; P = .045), and age <18 years (OR, 4.1; 95% CI, 0.8-22.1; P = .015). Conclusion: Despite the addition of an LET, almost 20% of patients undergoing ACLR with hamstring tendon autografts experienced graft rupture when PTS was ≥12°. When combined with an increased SATT (≥5 mm), the graft rupture rate rose to 26%. In contrast, no graft ruptures were observed in patients with a PTS <9°. These findings emphasize the importance of evaluating PTS and SATT individually rather than systematically performing LET.

Background: Posterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure. Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized. Purpose: To determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR + LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities. Results: PTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5° to 9°, below which the risk of failure plateaued. In contrast, PTS values exceeding 11° to 12° were associated with high failure probabilities in both groups. Conclusion: PTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.

Osteopetrosis is a rare metabolic bone disease, characterized by dysfunction of osteoclasts, resulting in increased bone density and brittleness leading to pathological fractures and bone deformities. Hip and knee osteoarthritis (OA) are common long-term complications in patients with osteopetrosis. Joint arthroplasty surgery remains an effective and recommended treatment for these patients with an end-stage OA because it provides favorable outcomes. However, in osteopetrosis, joint arthroplasty surgery carries an increased risk of complications, and specific preoperative and perioperative considerations are required to deal with the technical challenges related to the disease. The aim of this article was to review some of the key aspects of osteopetrosis, provide technical recommendations, and answer clinically relevant questions related to hip and knee arthroplasty surgery.