Increased Lateral Tibial Plateau Slope Predisposes Male College Football Players to ACL Injury

Purpose To compare anterior cruciate ligament (ACL)–injured and ACL-intact patients as well as males and females in terms of tibial plateau slopes to determine their association with ACL injury. Methods Magnetic resonance images (MRI) of the knee of 310 male and 179 female skeletally mature Indian patients (mean age, 40 years) with (n=170+29) or without (n=140+150) ACL injury were reviewed. Their medial and lateral tibial plateau slopes (MTPS and LTPS), medial tibial plateau depth (MTPD), and lateral tibial plateau height (LTPH) were measured using MRI. Results The ACL-injured and ACL-intact groups were comparable in terms of MTPS (6.72° vs. 6.73°, p=0.07), LTPS (5.68° vs. 5.70°, p=0.09), MTD (1.74 vs. 1.73 mm, p=0.356), and LTH (2.21 vs. 2.22 mm, p=0.393). Males and females were also comparable in terms of MTPS and LTPS in both ACL-injured and ACL-intact groups. Conclusion ACL-injured and ACL-intact patients as well as males and females were comparable in terms of the tibial plateau slope parameters.

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Reliability of Plain Radiographs Versus Magnetic Resonance Imaging to Measure Tibial Slope in Sports Medicine Patients: Can They Be Used Interchangeably?

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211033882 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110338

Author(s):

Ryan Jahn ◽

Joseph D. Cooper ◽

Tristan Juhan ◽

Hyunwoo P. Kang ◽

Ioanna K. Bolia ◽

...

Keyword(s):

Sports Medicine ◽

Tibial Plateau ◽

Interobserver Reliability ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Tibial Slope ◽

Lateral Tibial Plateau ◽

Tibial Plateau Slope ◽

Mri Scans ◽

Mri Measurements

Background: The slope of the tibial plateau has been proposed as a reason for failure of anterior cruciate ligament reconstruction. Purpose: To evaluate the interobserver reliability of measurements of tibial slope on radiographs versus magnetic resonance imaging (MRI) scans and to assess whether the modalities can be used interchangeably for this purpose. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This retrospective study included 81 patients aged 18 to 30 years who were evaluated in a sports medicine setting for knee pain and who had lateral knee radiographs as well as knee MRI scans on file. Medial and lateral tibial plateau slope measurements were made by 3 blinded reviewers from the radiographs and MRI scans using graphic overlay software. The paired t test was used to compare measurements of the medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) from radiographs and MRI scans. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver reliability of measurements within each imaging modality, and Pearson correlation coefficients were calculated to determine the relationship between measurements on radiographs versus MRI scans. Results: Imaging from 81 patients were included. The average MTPS was significantly larger on radiographs compared with MRI scans (8.7° ± 3.6° vs 3.7° ± 3.4°; P < .001), and the average LTPS was also significantly larger on radiographs compared with MRI scans (7.9° ± 3.4° vs 5.7° ± 3.7°; P < .001). ICC values indicated good to excellent intraobserver agreement for all imaging modalities (ICC, 0.81-0.97; P ≤ .009). The ICCs for interobserver reliability of MTPS and LTPS measurements were 0.92 and 0.85 for radiographs, 0.87 and 0.83 for MRI based off the subchondral bone, and 0.86 and 0.71 for MRI based off the cartilage, respectively ( P < .001). Medium correlation was noted between radiographic and MRI measurements; Pearson correlation coefficients for radiographic versus subchondral MRI measurements were 0.30 and 0.37 for MTPS and LTPS, respectively. Conclusion: The average MTPS and LTPS were significantly larger on radiographs compared with MRI scans. Although tibial slope measurements using radiography and those using MRI are reliable between individuals, the measurements from radiographs and MRI scans cannot be used interchangeably, and caution should be used when interpreting and comparing studies using measurements of the tibial slope.

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A Quantifiable Risk Factor for ACL Injury: Applied Mathematics to Model the Posterolateral Tibial Plateau Surface Geometry

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121998310 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199831

Author(s):

Jimmy Tat ◽

Drew Crapser ◽

Motaz Alaqeel ◽

Justin Schupbach ◽

Jacob Lee-Howes ◽

...

Keyword(s):

Internal Rotation ◽

Tibial Plateau ◽

Applied Mathematics ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Acl Injury ◽

Surface Geometry ◽

Lateral Tibial Plateau ◽

Acl Injuries ◽

Significant Difference

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau. Purpose/Hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. The hypothesis was that increased convexity and steepness of the posterior aspect of the lateral plateau would subject knees to higher forces, leading to a potentially higher risk of ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We mathematically modeled the posterior curvature of the lateral tibial plateau in 64 patients with ACL injuries and 68 matched controls. Using sagittal magnetic resonance imaging scans of the knee, points on the articular cartilage of the posterolateral tibial plateau were selected and curve-fitted to a power function ( y = a × xn). For coefficient a and coefficient n, both variables modulated the shape of the curve, where a larger magnitude represented an increase in slope steepness. Groups were compared using a Mann-Whitney test and α < .05. Results: There was a significant difference in surface geometry between the patients with ACL injuries and matched controls. The equation coefficients were significantly larger in the patients with ACL injuries: coefficient a (ACL injury, 0.9 vs control, 0.68; P < .0001) and coefficient n (ACL injury, 0.34 vs control, 0.30; P = .07). For coefficient a, there was a 78.9% sensitivity, 77.5% specificity, and odds ratio of 12.6 (95% CI, 5.5-29.0) for ACL injury using a cutoff coefficient a = .78. Conclusion: Patients with ACL injuries had a significantly greater posterolateral plateau slope. The steeper drop off may play a role in higher anterior translation forces, coupled with internal rotation torques on the knee in noncontact injury, which could increase ACL strain and predispose to ACL injury.

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Normal anatomical variations of tibial plateau geometry in Indian population: a magnetic resonance image-based study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210625 ◽

2021 ◽

Vol 7 (2) ◽

pp. 319

Author(s):

Gopal Ghosh ◽

Shabarna Roy

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Image ◽

Injury Risk ◽

Tibial Plateau ◽

Tibial Osteotomy ◽

Medial Tibial Plateau ◽

Lateral Tibial Plateau ◽

Female Population ◽

Population Mean ◽

Tibial Plateau Slope

Background: Geometry of tibial plateau characterized by its medial tibial plateau slope (MTS), lateral tibial plateau slope (LTS), depth of concavity of medial tibial plateau (CMT), convexity of lateral tibial plateau on sagittal section and coronal tibial plateau slope (CTS) on coronal section of tibia.Methods: 500 subjects (male-250, female-250) were included in the study. Various tibial slopes of each subject were measured using magnetic resonance image (MRI) of knee joint. Data was analysed using appropriate statistical analysis.Results: When considering male and female one group (total population) mean (±SD) of MTS, LTS, CMT, CTS were 7.73±3.200, 4.68±2.750, 2.56±0.56 mm and 2.61±2.150 respectively. In male population mean (±SD) of MTS, LTS, CMT, CTS were 6.94±3.20, 3.77±1.850, 2.7±0.55 mm, 3.06±2.390 respectively. In female population population mean (±SD) of MTS, LTS, CMT, CTS were 9.28±2.650, 6.45±3.360, 2.28±0.48 mm, 1.75±1.240 respectively. Over all MTS and LTS was poorly correlated (r=0.43). Female had significant steeper MTS (p=0.013) and LTS (p=0.001) but had less CTS (p=0.04) and shallow CMT (p=0.012) compared to male.Conclusions: Knowledge of this study could be used in different operative orthopaedic procedures (like knee arthroplasty, high tibial osteotomy, tibial plateau fracture fixation), non-contact ACL injury risk assessment.

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MEDIAL AND LATERAL POSTERIOR TIBIAL SLOPE IN THE SKELETALLY IMMATURE: A HUMAN CADAVERIC STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00130 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0013

Author(s):

Nicolas G. Anchustegui ◽

Audrey Rustad ◽

Cooper Shea ◽

Stockton Troyer ◽

Aleksei Dingel ◽

...

Keyword(s):

Tibial Plateau ◽

Femoral Condyle ◽

Slope Angle ◽

Acl Injury ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Skeletally Immature ◽

Lateral Tibial Plateau ◽

Posterior Tibial ◽

Text Figure

Background: Recent research has identified posterior tibial slope as a risk factor for anterior cruciate ligament (ACL) injury, due to increased forces on the ACL with this tibial anatomy. Biomechanical studies suggest that altering a patient’s posterior tibial slope may lower the risk of ACL injury. Due to the presence of an open physis, guided growth may be used to reduce the posterior tibia slope in this high risk skeletally immature population. The primary purpose of this study was to quantify and measure the posterior tibial slope in pediatric knees. Methods: Forty-four pediatric knee CT scans were analyzed using OsiriX, an imaging software. Specimens analyzed were between the ages of 2 and 12 years of age. The proximal tibial slope for each specimen was measured on CT scan sagittal slices at 2 locations: 1) At the medial tibial plateau at the mid region of the medial femoral condyle, as determined on a coronal slice through the femoral condyle; 2) At the lateral tibial plateau at the mid region of the lateral femoral condyle, as determined on the coronal slice through the femoral condyle. The measurement of the posterior tibial slope was determined by placing two lines parallel to the diaphysis of the tibia, one located in the middle of the diaphysis and one located at the most posterior aspect of the diaphysis. The most proximal aspect of both the medial and lateral tibial plateau were then identified and angle measurements were taken in reference to the parallel lines. The angle measurements were plotted graphically by age in order to account for variability in development within age groups. The anterior medial and lateral tibia plateau widths were measured by identifying the mid region of the respective plateaus. From this point, the distance between the top of the tibial plate and the physis was measured. Results: The average posterior tibial slope angle for the medial and lateral tibial plateau were (5.53° ± 4.17°) and (5.95° ± 3.96°) respectively. Independent samples t-test and ANOVA indicate the difference between the posterior tibial slope angle of the medial and lateral tibial plateau were not statistically significant (p < 0.05). When plotted graphically by age, a slight negative trend between age and posterior tibial slope was identified. As age increases, the medial and lateral posterior tibial slope decreases. The mean anterior medial tibial plateau width and lateral tibial plateau width were .99 cm and 1.19 cm respectively. Discussion/Conclusion: ACL primary and secondary injury occur at very high rates in the skeletally immature, especially in females at age 11 and older, and in males at age 13 and older. This data set offers some preliminary values for posterior tibial slope in patients without a history of ACL injury, allowing for comparisons to patients with ACL Injury. Increased tibial slope is a risk factor for ACL injury. In the skeletally immature, one option to alter the tibial slope is the use of guided growth with implants to slow the anterior growth of the proximal tibia, reducing the posterior slope of the tibia, and possibly lower the risk of ACL injury in this high-risk population. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Table: see text][Table: see text]

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