Defining sagittal knee phenotypes via monopedal static anterior tibial translation. Part 2: The assessment‐led personalization (ALP) system for indication and correction target planning in slope‐reducing osteotomy

Current decision‐making for slope‐reducing osteotomy (SRO) often relies on isolated posterior tibial slope (PTS) thresholds, potentially misidentifying patients with acquired soft‐tissue decompensation or possibly overtreating those with an asymptomatic, inherently hyperlax baseline. Furthermore, rigid point‐based scoring systems oversimplify the synergistic biomechanics of the anterior cruciate ligament‐deficient knee. Building on the foundational ‘Set‐Point’ theory established in Part 1, this paper introduces the assessment‐led personalization (ALP) system. This unified clinical algorithm integrates the normalized percentage of absolute static anterior tibial translation (sATT%) and its side‐to‐side difference (ΔsATT%) with PTS laterality, generalized hyperlaxity, and injury chronicity. By mathematically calibrating raw translation data to isolate true soft‐tissue decompensation from underlying osseous asymmetry, the ALP system provides a proactive, joint‐preserving framework to identify high‐risk phenotypes likely to fail isolated soft‐tissue reconstruction and precisely refines the indications for SRO.

Level of Evidence

Level V.