Assessment and surgical correction of posterior tibial slope in revision anterior cruciate ligament surgery: An international expert Delphi consensus statement
Bibliographic record
Abstract
PURPOSE: The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR). METHODS: This guideline is based on responses from 46 international orthopaedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80 % of survey respondents fully agreed. RESULTS: With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5-7°, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians' decision-making in revision ACLR management and to focus future areas of required research. CONCLUSION: The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78 %) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects. LEVEL OF EVIDENCE: V, expert opinion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.157 | 0.102 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.007 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".