scholarly journals The difference between the medial and lateral posterior tibial slope is associated with greater internal tibial rotation

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0003
Author(s):  
Elmar Herbst ◽  
Andreas Imhoff ◽  
James Irrgang ◽  
William Anderst ◽  
Freddie Fu
Keyword(s):  
Acl Reconstruction ◽  
Tibial Slope ◽  
Tibial Rotation ◽  
Tibial Shaft ◽  
Posterior Tibial ◽  
Downhill Running ◽  
Lateral Posterior ◽  
Internal Tibial Rotation ◽  
The Difference

The objective of this study was to investigate the effect of lateral and medial posterior tibial slope (PTS) and meniscal slope (PMS) on in-vivo anterior tibial translation (ATT) and internal tibial rotation (IR) during downhill running on the healthy contralateral knee twenty-four months after ACL reconstruction. Forty-two individuals (twenty-six males; mean age 21.2 ± 6.9 years) who underwent unilateral ACL reconstruction were included in this study. Morphologic parameters were measured on 3 T magnetic resonance images (MRI) using the 3D DESS sequence on the ACL reconstructed and healthy contralateral knee. Lateral and medial PTS and PMS were measured according to the method described by Hudek et al. Briefly, the tibial shaft axis was determined by connecting the centroids of two circles fitting the tibial shaft on the central sagittal MRI slice. The PTS and PMS were determined by the angle between the tibial shaft axis and the line connecting the two most proximal anterior and posterior subchondral bone and meniscal points in the center of each joint compartment. Three-dimensional in-vivo kinematics data were acquired using dynamic stereo x-ray during downhill running (3.0 m/s, 10° slope) at 150 Hz twenty-four months after unilateral ACL reconstruction. A multiple regression analysis was performed (p < .05). The lateral and medial PTS and PMS as well as the differences between the medial and lateral compartment slopes were not significantly related to ATT in the healthy contralateral knees twenty-four months after ACL reconstruction (p > .05). The lateral and medial PTS and PMS were not significantly related to peak internal tibial rotation (p > .05). However, the difference between the medial and lateral PTS as well as PMS was associated with greater internal tibial rotation (PTS: b=1.55, p < .001; PMS: b = .71, p = .02). The most important finding of the present study is that the difference between the medial and lateral posterior tibial and meniscal slope are related to in-vivo internal tibial rotation during downhill running. ATT was not significantly influenced by the tibial bony and meniscal morphology. Taking into account the results of the present study, the difference between the medial and the lateral PTS and PMS may contribute to IR when an ACL injury occurs. However, the analyzed movement was a straight-ahead run without any cutting or pivoting maneuvers commonly related to ACL tears. In such motion patterns, the correlations may be even stronger compared to the results of this study.

Adjusting Insert Thickness and Tibial Slope Do Not Correct Internal Tibial Rotation Loss Caused by PCL Resection: In Vitro Study of a Medial Constraint TKA Implanted with Unrestricted Calipered Kinematic Alignment

2021 ◽  
Author(s):  
Alexander J. Nedopil ◽  
Peter J. Thadani ◽  
Thomas H. McCoy ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Internal Rotation ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Kinematic Alignment ◽  
Tibial Rotation ◽  
Medial Condyle ◽  
Maximum Extension ◽  
Posterior Tibial ◽  
Internal Tibial Rotation ◽  
Lift Off

AbstractMost medial stabilized (MS) total knee arthroplasty (TKA) implants recommend excision of the posterior cruciate ligament (PCL), which eliminates the ligament's tension effect on the tibia that drives tibial rotation and compromises passive internal tibial rotation in flexion. Whether increasing the insert thickness and reducing the posterior tibial slope corrects the loss of rotation without extension loss and undesirable anterior lift-off of the insert is unknown. In 10 fresh-frozen cadaveric knees, an MS design with a medial ball-in-socket (i.e., spherical joint) and lateral flat insert was implanted with unrestricted calipered kinematic alignment (KA) and PCL retention. Trial inserts with goniometric markings measured the internal–external orientation relative to the femoral component's medial condyle at maximum extension and 90 degrees of flexion. After PCL excision, these measurements were repeated with the same insert, a 1 mm thicker insert, and a 2- and 4-mm shim under the posterior tibial baseplate to reduce the tibial slope. Internal tibial rotation from maximum extension and 90 degrees of flexion was 15 degrees with PCL retention and 7 degrees with PCL excision (p < 0.000). With a 1 mm thicker insert, internal rotation was 8 degrees (p < 0.000), and four TKAs lost extension. With a 2 mm shim, internal rotation was 9 degrees (p = 0.001) and two TKAs lost extension. With a 4 mm shim, internal rotation was 10 degrees (p = 0.002) and five TKAs lost extension and three had anterior lift-off. The methods of inserting a 1 mm thicker insert and reducing the posterior slope did not correct the loss of internal tibial rotation after PCL excision and caused extension loss and anterior lift-off in several knees. PCL retention should be considered when using unrestricted calipered KA and implanting a medial ball-in-socket and lateral flat insert TKA design, so the progression of internal tibial rotation and coupled reduction in Q-angle throughout flexion matches the native knee, optimizing the retinacular ligaments' tension and patellofemoral tracking.

scholarly journals Posterior Tibial Subchondral Bone and Meniscal Slope Correlate with In Vivo Internal Tibial Rotation

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0030
Author(s):  
Elmar Herbst ◽  
Tom Gale ◽  
Kanto Nagai ◽  
Yasutaka Tashiro ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Subchondral Bone ◽  
Tibial Rotation ◽  
Posterior Tibial ◽  
Internal Tibial Rotation

Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race

2016 ◽  
Vol 45 (1) ◽  
pp. 106-113 ◽  
Author(s):  
Douglas S. Weinberg ◽  
Drew F.K. Williamson ◽  
Jeremy J. Gebhart ◽  
Derrick M. Knapik ◽  
James E. Voos
Keyword(s):  
Cruciate Ligament ◽  
Tibial Slope ◽  
Axial Rotation ◽  
Posterior Tibial Slope ◽  
Normative Values ◽  
Tibial Rotation ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean

Background: Injuries to the anterior cruciate ligament (ACL) are common, and a number of knee morphological variables have been identified as risk factors for an ACL injury, including the posterior tibial slope (TS). However, limited data exist regarding innate population differences in the TS. Purpose: To (1) establish normative values for the medial and lateral posterior TS; (2) determine what differences exist between ages, sexes, and races; and (3) determine how internal or external tibial rotation (as occurs during sagittal knee motion) influences the stereotactic perception of the TS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 545 cadaveric specimens (1090 tibiae) were obtained from the Hamann-Todd osteological collection. Specimens were leveled in the coronal, sagittal, and axial planes using a digital laser. Virtual representations of each bone were created with a 3-dimensional digitizer apparatus. The TS of the medial and lateral tibial plateaus were measured using techniques adapted from previous radiographic protocols. Medial and lateral TS were then again measured on 200 tibiae that were internally and externally rotated by 10° (axially). Results: The mean (±SD) medial TS was 6.9° ± 3.7° posterior, which was greater than the mean lateral TS of 4.7° ± 3.6° posterior ( P < .001). Neither the medial nor lateral TS changed with age. Women had a greater mean TS compared with men on both the medial (7.5° ± 3.8° vs 6.8° ± 3.7°, respectively; P = .03) and lateral (5.2° ± 3.5° vs 4.6° ± 3.5°, respectively; P = .04) sides. Black specimens had a greater mean medial TS (8.7° ± 3.6° vs 5.8° ± 3.3°, respectively; P < .001) and lateral TS (5.9° ± 3.3° vs 3.8° ± 3.5°, respectively; P < .001) compared with white specimens. Axial rotation was shown to increase the perception of the medial and lateral TS ( P < .001). Conclusion: The medial TS was shown to be greater than the lateral TS. Important sex- and race-based differences exist in the TS. This study also highlights the role of axial rotation in measuring the TS.

scholarly journals What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ning Fan ◽  
Yong-chen Zheng ◽  
Lei Zang ◽  
Cheng-gang Yang ◽  
Shuo Yuan ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Control Groups ◽  
Posterior Tibial ◽  
Notch Width ◽  
Lateral Posterior ◽  
And Control ◽  
Pcl Avulsion ◽  
Notch Width Index

Abstract Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture. Methods 76 patients (comprised 40 men and 36 women) with PCL avulsion fracture and 76 age- and sex-matched controls without PCL avulsion fracture were studied from 2012 to 2020. MRI measurements of the knee were acquired in the sagittal, coronal, and axial planes. The assessed measurements including intercondylar notch width index, coronal tibial slope, and medial/lateral posterior tibial slopes were compared between men and women, and between case and control groups respectively using independent sample t-tests. In addition, binary logistic regression analyses were used to identify independent risk factors of PCL avulsion fracture. Results Except notch width index (coronal) (p = 0.003) in the case groups, there was no statistical difference in the assessed measurements including notch width index (axial), coronal tibial slope, medial posterior tibial slope, and lateral posterior tibial slope between men and women in the case and control groups (p > 0.05). When female patients were analyzed, the notch width index (coronal) was significantly smaller (p = 0.0004), the medial posterior tibial slope (p = 0.018) and the lateral posterior tibial slope (p = 0.033) were significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.347, OR = 0.707, p = 0.003) was found to be an independent factor of PCL avulsion fracture. However, none of the assessed measurements was found to have a statistical difference between the case and control groups in men (p > 0.05). Conclusions Notch width index (coronal), medial posterior tibial slope, and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.

scholarly journals ACL rupture and posterior tibial slope - how do we handle this?

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0028
Author(s):  
Jörg Dickschas
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Plate Osteosynthesis ◽  
Critical Role ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Tibial Osteotomy ◽  
Posterior Tibial ◽  
Closed Wedge

Aims and Objectives: In recent publications on acl-ruptures and especially on failure of acl reconstruction there comes a strong focus on posterior tibial slope (PTS). ACL reconstructions with a PTS of >12° have an 8 times higher risk of recurrent instability and reconstruction failure. But many questions stay unclear so far-When do we have to correct the tibial slope? How do we correct it? What about simultaneous frontal axis deviations? In this publication a new algorhythm is presented. Materials and Methods: The following aspects have to be evaluated Is the PTS the only dimension of the deformity or do we have to correct the frontal axis simultaneuosly? Performing a anterior closed wedge extension osteotomy: when do we go distal the tuberosity and when do we perform a tuberosity osteotomy and use it as “bio plating”? Osteosynthesis only screws or always plate? Are there indications for a contineous correction, f.e. with a hexapod? Whats the role of preoperative range of motion of the knee (especially extension)? Always tunnel filling in the same surgery? What about PCL insufficiency and low PTS? Results: An algorhythm is presented giving a treatment path for the different questions mentioned. The procedures are shown step by step in clinical examples and surgery documentation for every pathway. Conclusion: Posterior tibial slope plays an critical role in ACl recontruction. In primary ACl tear a slope correction is probably not indicated. In ACL reconstruction failure a analysis of the PTS needs to be done and correction needs to be discussed. Simultaneuous varus deormities need to be corrected by openwedge valgisation - extension high tibial osteotomy (HTO), while as isolated PTS elevation is subject to an anterior closed wedge extension HTO. Preoperative range of motion needs to be respected not to create hyperextension. Osteosynthesis can be perormed with only screws using the tibial tubercle as “bio-plating”. In cases of former bone-tendeon-bone (BTB) ACL reconstruction a tibial tubercle osteotomy should be avoided and a infratuberositeal osteotomy should be performed and stabilized with plate osteosynthesis. In severe postraumatic cases contineous correction of the slope with fixateur externe, f.e. hexapodes, needs to be performed.

scholarly journals Body Mass Index, Modulated by Lateral Posterior Tibial Slope, Predicts ACL Injury Risk

2016 ◽  
Vol 4 (7_suppl4) ◽  
pp. 2325967116S0012
Author(s):  
Katherine M. Bojicic ◽  
Melanie L. Beaulieu ◽  
Daniel Imaizumi Krieger ◽  
James A. Ashton-Miller ◽  
Edward M. Wojtys
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Injury Risk ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
Acl Injury Risk

scholarly journals The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M.J.M Zee ◽  
M.N.J Keizer ◽  
L Dijkerman ◽  
J.J.A.M van Raaij ◽  
J.M. Hijmans ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Dynamic Range ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Before And After ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study

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