Posterior tibial slope (PTS) is frequently discussed as a potential contributor to ligament reconstruction outcomes, yet its role in posterior cruciate ligament (PCL) surgery remains unclear. In this multicenter study involving 173 patients who underwent isolated PCL reconstruction or PCL-based multiligament knee reconstruction, we investigated whether PTS influences the risk of reconstruction failure. Despite a slightly higher mean PTS in patients who experienced failure, survival analyses did not demonstrate a significant association between PTS and reconstruction outcomes. Overall, PTS was not found to be an independent risk factor for failure after PCL reconstruction.

These findings suggest that posterior tibial slope alone may have a limited impact on PCL reconstruction survivorship and do not support routine slope-correcting procedures in the setting of primary PCL reconstruction.