scholarly journals Knees with Smaller Posterior Tibial Slope And More Concave Medial Tibial Plateau Are At Higher Risk Of Isolated Meniscal Injuries

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Martha Murray ◽  
Ata Kiapour ◽  
Samuel Barnett
Keyword(s):  
Tibial Plateau ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Meniscus Tear ◽  
Medial Tibial Plateau ◽  
Shear Forces ◽  
Anatomical Features ◽  
Posterior Tibial ◽  
Increased Risk ◽  
Meniscus Tears

Objectives: Meniscal injuries are extremely common. Several anatomical features of the knee, including the tibial plateau morphology, have been shown to influence knee biomechanics and the risk of ligamentous injuries. Little is known, however, how these morphological features influence the risk of isolated meniscal injuries in the ACL intact knee. In the current study, we used MRI and 3D image analysis to investigate anatomical variables of knees in patients with and without isolated meniscus tears. We hypothesized that there are differences in slopes and concavity of the tibial plateau between patients with isolated meniscus tears and matched normal controls. Methods: 65 subjects with first-instance isolated medial or lateral meniscal injuries requiring surgical fixation (Age: 15 +/- 2 years, BMI: 23.2 +/- 3.7 Kg/m2; 43% females) were matched to 65 subjects with normal knees and no prior injuries (Age: 15 +/- 2 years, BMI: 23.1 +/- 3.8 Kg/m2; 43% females) based on age, BMI and sex. Sagittal Proton Density SPACE MR images (preoperative for injured group) were used to measure the posterior slope of the medial (MTS) and lateral (LTS) tibial plateau, coronal slope of the tibial plateau (CTS), and the maximum depth of the medial tibia plateau (MTD, as a measure of medial tibial plateau concavity), following established techniques-Figure 1. Two-sample t-test was used to compare the quantified anatomical features between the cases and matched controls. Results: There were no differences in age (p = 0.999), sex distribution (p = 0.999) and BMI (p = 0.963) between the two cohorts. Compared to matched controls, patients with isolated meniscal tears had lower LTS (3.6 +/- 3.2 vs 5.6 +/- 3.0 degrees; p < 0.001), lower MTS (3.4 +/- 2.9 vs 4.9 +/- 2.5 degrees; p = 0.001) and deeper MTD (2.4 +/- 0.8 vs 1.5 +/- 0.8 mm; p < 0.001). There was no difference in CTS between the groups (3.6 +/- 1.6 vs 3.9 +/- 2.2 degrees; p = 0.300). Conclusion: This study suggests that subjects with isolated meniscus tear have a lower posterior tibial slope and a deeper MTD (more concave medial tibial plateau) than matched population who do not have a meniscus tear. This is contrary to what is known for ACL tears, where a higher posterior tibial slope and a shallower MTD have been associated with an increased risk of ACL tear. During load-bearing activities, in particular high impact movements such as jumping, increased tibial slope and decreased MTD have shown to result in greater anterior shear forces across the knee. In contrast, the less sloped and more concave plateau will experience lower shear forces but more compression, which could be detrimental to the meniscus. This study provides preliminary evidence suggesting a link between tibial plateau morphology and risk of isolated meniscal injuries. Further mechanistic studies are required to better understand the interaction between knee morphology, meniscal loading and subsequent risk of injury. [Figure: see text]

Steep Posterior Tibial Slope, Anterior Tibial Subluxation, Deep Posterior Lateral Femoral Condyle, and Meniscal Deficiency Are Common Findings in Multiple Anterior Cruciate Ligament Failures: An MRI Case-Control Study

2019 ◽  
Vol 47 (2) ◽  
pp. 285-295 ◽  
Author(s):  
Alberto Grassi ◽  
Luca Macchiarola ◽  
Francisco Urrizola Barrientos ◽  
Juan Pablo Zicaro ◽  
Matias Costa Paz ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Tibial Slope ◽  
Lateral Femoral Condyle ◽  
Posterior Tibial Slope ◽  
Control Group ◽  
Medial Tibial Plateau ◽  
Posterior Tibial ◽  
Anterior Tibial

Background: Tibiofemoral anatomic parameters, such as tibial slope, femoral condyle shape, and anterior tibial subluxation, have been suggested to increase the risk of anterior cruciate ligament (ACL) reconstruction failure. However, such features have never been assessed among patients experiencing multiple failures of ACL reconstruction. Purpose: To compare the knee anatomic features of patients experiencing a single failure of ACL reconstruction with those experiencing multiple failures or with intact ACL reconstruction. Study: Case-control study; Level of evidence, 3. Methods: Twenty-six patients who experienced failure of revision ACL reconstruction were included in the multiple-failure group. These patients were matched to a group of 25 patients with failure of primary ACL reconstruction and to a control group of 40 patients who underwent primary ACL reconstruction with no failure at a minimum follow-up of 24 months. On magnetic resonance imaging (MRI), the following parameters were evaluated: ratio between the height and depth of the lateral and medial femoral condyles, the lateral and medial tibial plateau slopes, and anterior subluxation of the lateral and medial tibial plateaus with respect to the femoral condyle. The presence of a meniscal lesion during each procedure was evaluated as well. Anatomic, demographic, and surgical characteristics were compared among the 3 groups. Results: The patients in the multiple-failure group had significantly higher values of lateral tibial plateau slope ( P < .001), medial tibial plateau slope ( P < .001), lateral tibial plateau subluxation ( P < .001), medial tibial plateau subluxation ( P < .001), and lateral femoral condyle height/depth ratio ( P = .038) as compared with the control group and the failed ACL reconstruction group. Moreover, a significant direct correlation was found between posterior tibial slope and anterior tibial subluxation for the lateral ( r = 0.325, P = .017) and medial ( r = 0.421, P < .001) compartments. An increased anterior tibial subluxation of 2 to 3 mm was present in patients with a meniscal defect at the time of the MRI as compared with patients who had an intact meniscus for both the lateral and the medial compartments. Conclusion: A steep posterior tibial slope and an increased depth of the lateral femoral condyle represent a common finding among patients who experience multiple ACL failures. Moreover, higher values of anterior subluxation were found among patients with repeated failure and those with a medial or lateral meniscal defect.

scholarly journals Importance of Posterior Tibial Slope, Medial Tibial Plateau Slope and Lateral Tibial Plateau Slope in Anterior Cruciate Ligament Injury

2021 ◽  
Vol 11 (09) ◽  
pp. 233-248
Author(s):  
Bernat Mas Matas ◽  
Irene Carrión Barberà ◽  
Salvatore Marsico ◽  
Anna Agustí Claramunt ◽  
Raúl Torres-Claramunt ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Ligament Injury ◽  
Medial Tibial Plateau ◽  
Lateral Tibial Plateau ◽  
Posterior Tibial ◽  
Tibial Plateau Slope ◽  
Anterior Cruciate

The Medial Tibial Plateau Can Be Used as a Direct Anatomical Reference for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty

2021 ◽  
Author(s):  
Shigeshi Mori ◽  
Masao Akagi ◽  
Akihiro Moritake ◽  
Ichiro Tsukamoto ◽  
Kotaro Yamagishi ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Plateau ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
The Mean ◽  
Ct Data ◽  
The Individual

AbstractThere has been no consensus about how to determine the individual posterior tibial slope (PTS) intraoperatively. The purpose of this study was to investigate whether the tibial plateau could be used as a reference for reproducing individual PTS during medial unicompartmental knee arthroplasty (UKA). Preoperative computed tomography (CT) data from 48 lower limbs for medial UKA were imported into a three-dimensional planning software. Digitally reconstructed radiographs were created from the CT data as the lateral knee plain radiographs and the radiographic PTS angle was measured. Then, the PTS angles on the medial one-quarter and the center of the MTP (¼ and ½ MTP, respectively), and that on the medial tibial eminence (TE) were measured on the sagittal multiplanar reconstruction image. Finally, 20 lateral knee radiographs with an arthroscopic probe placed on the ¼ and the ½ MTP were obtained intraoperatively, and the angle between the axis of the probe and the tangent line of the plateau was measured. The mean radiographic PTS angle was 7.9 ± 3.0 degrees (range: 1.7–13.6 degrees). The mean PTS angles on the ¼ MTP, the ½ MTP, and the TE were 8.1 ± 3.0 degrees (1.2–13.4 degrees), 9.1 ± 3.0 degrees (1.4–14.7 degrees), and 9.9 ± 3.1 degrees (3.1–15.7 degrees), respectively. The PTS angles on the ¼ MTP and the ½ MTP were strongly correlated with the radiographic PTS angle (r =0.87 and 0.80, respectively, p < 0.001). A statistically significant difference was observed between the mean angle of the radiographic PTS and the PTS on the TE (p < 0.01). The mean angle between the axis of the probe and the tangent line of the tibial plateau was −0.4 ± 0.9 degrees (−2.3–1.3 degrees) on the ¼ MTP and −0.1 ± 0.7 degrees (−1.5–1.2 degrees) on the ½ MTP, respectively. An area from the medial one-quarter to the center of the MTP could be used as an anatomical reference for the individual PTS.

Low posterior tibial slope is associated with increased risk of PCL graft failure

2022 ◽  
Author(s):  
Philipp W. Winkler ◽  
Nyaluma N. Wagala ◽  
Sabrina Carrozzi ◽  
Ehab M. Nazzal ◽  
Michael A. Fox ◽  
...  
Keyword(s):  
Graft Failure ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Increased Risk

scholarly journals Estimation of the posterior tibial slope on magnetic resonance images in Serbian population

2018 ◽  
Vol 75 (2) ◽  
pp. 154-158
Author(s):  
Natasa Janjusevic ◽  
Maja Vulovic ◽  
Aleksandar Radunovic ◽  
Milan Jovanovic ◽  
Jasenka Vasic-Vilic ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Tibial Plateau ◽  
Statistical Tests ◽  
Tibial Slope ◽  
Magnetic Resonance Images ◽  
Posterior Tibial Slope ◽  
Mean Values ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Medial Tibial Slope

Background/Aim. Preservation of an adequate posterior tibial slope (PTS) during total knee arthroplasty is crucial for the biomechanical stability and function of the knee joint. Studies that investigated anatomical features of the tibial plateau found significant gender and inter-population differences in all components of the PTS. The aim of this study was to establish reference values of PTS in Serbian population and to explore if there is any difference in the tibial plateau inclination between genders. Methods. We retrospectively reviewed 161 magnetic resonance images (MRIs) of the knee of adult patients examined in Medical Military Academy in Belgrade, Serbia, in a period from November 2011 to September 2014. Measurements of PTS components: medial tibial slope (MTS), lateral tibial slope (LTS), and coronal tibial slope (CTS) were performed through several steps, according to the suggestions in the recent literature. Obtained values for each tibial slope were compared between gender subgroups using appropriate statistical tests. Results. Mean values of each component of the posterior tibial slope for male vs. female subgroups were as follows: MTS 3.7? ? 2.8? vs. 5.1? ? 2.9?, LTS 4.2? ? 2.8? vs. 4.3? ? 2.7?, and CTS 3.9? ? 2.4? vs. 3.3? ? 1.9? respectively. The medial tibial slope was significantly higher in females than in males (p = 0.005). The mean value of the coronal tibial slope was greater in males without statistically significant difference (p = 0.105). Conclusion. This study demonstrated significant difference in MTS of the tibial plateau between males and females, being higher in the female subgroup.

scholarly journals High Posterior Tibial Slope Influence Medial Meniscus Injuries in ACL Deficient Knees

2018 ◽  
Vol 69 (11) ◽  
pp. 3295-3298
Author(s):  
Iulian Marcu ◽  
Ana Maria Oproiu ◽  
Nicolae Mihailide
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Meniscus Tear ◽  
Meniscus Lesion ◽  
Posterior Tibial ◽  
Meniscus Lesions ◽  
The Mean ◽  
Meniscus Injuries

The purpose of the current study was to evaluate the correlation between the tibial slope and medial meniscus injury in anterior cruciate ligament deficient knees. A total of 223 patients with primary ACL injury admitted to Foisor Orthopedic Hospital between 2015-2016 were included in this study. The posterior tibial slope was evaluated on a lateral x-ray view of the knee and was defined as the angle between the line joining the tibial plateau and the line perpendicular to the longitudinal axis (the proximal tibial anatomical axis). Patients were divided into two groups depending on the posterior tibial slope ([9.9 and �10), and a Chi square test was used to evaluate if there is any correlation between this and internal meniscus injuries, and Fisher�s exact test was used to verify this. Overall medial meniscus lesions were found in 43.5% of the patients. The mean value of the posterior tibial slope was 11.19+/-2,685. After grouping patients in low and high group ([9.9 and �10), there were 66.8% in the high tibial slope group and 33.2% in the low group. In the high PTS group there were 93 patients with medial meniscus lesion (62.4%), and 56 (37.6%) without medial meniscus lesion. The mean posterior tibial slope was higher in the medial meniscus tear group (11.78 degrees), than mean PTS in the group without medial meniscus lesion (10.42 degrees). There was a strong correlation between high tibial slope and medial meniscus lesions (p=0.015). The main finding of the current study is that there is a statistically significant correlation between posterior tibial slope higher than 10 degrees and internal meniscus tears.

scholarly journals Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711668866 ◽  
Author(s):  
Katherine M. Bojicic ◽  
Mélanie L. Beaulieu ◽  
Daniel Y. Imaizumi Krieger ◽  
James A. Ashton-Miller ◽  
Edward M. Wojtys
Keyword(s):  
Injury Risk ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Multivariate Logistic Regression ◽  
Acl Tear ◽  
Posterior Tibial ◽  
Increased Risk ◽  
Lateral Posterior ◽  
Acl Injury Risk

Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS ( P = .043) and MCS ( P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture ( P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.

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

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]

scholarly journals Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4272
Author(s):  
Jai Hyun Chung ◽  
Chong Hyuk Choi ◽  
Sung-Hwan Kim ◽  
Sung-Jae Kim ◽  
Seung-Kyu Lee ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Sagittal Plane ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Medial Tibial Plateau ◽  
Tibiofemoral Joint ◽  
Posterior Tibial ◽  
Group A ◽  
Osteotomy Line ◽  
Reconstructed Model

The posterior tibial slope of the tibiofemoral joint changes after medial open wedge high tibial osteotomy (MOWHTO), but little is known about the effect of the sagittal osteotomy inclination angle on the change in the posterior tibial slope of the tibiofemoral joint. The purpose of this study was to investigate the effect of the osteotomy inclination angle in the sagittal plane on changes in the posterior tibial slope after MOWHTO by comparing how anterior and posterior inclination affect the posterior tibial slope of the tibiofemoral joint. The correlation between the osteotomy inclination angle and the postoperative posterior tibial slope angle was also assessed. Between May 2011 and November 2017, 80 patients with medial compartment osteoarthritis who underwent MOWHTO were included. The patients were divided into two groups according to the sagittal osteotomy inclination angle on the 3D reconstructed model. Patients with an osteotomy line inclined anteriorly to the medial tibial plateau line were classified into group A (58 patients). Patients with posteriorly inclined osteotomy line were classified as group P (22 patients). In the 3D reconstructed model, the preoperative and postoperative posterior tibial slope, osteotomy inclination angle relative to medial tibial plateau line in sagittal plane, and gap distance and ratio of the anterior and posterior osteotomy openings were measured. The preoperative and postoperative hip-knee-ankle angle, weight-bearing line ratio, and posterior tibial slope were also measured using plain radiographs. In the 3D reconstructed model, the postoperative posterior tibial slope significantly increased in group A (preoperative value = 9.7 ± 2.9°, postoperative value = 10.7 ± 3.0°, p < 0.001) and decreased in group P (preoperative value = 8.7 ± 2.7°, postoperative value = 7.7 ± 2.7°, p < 0.001). The postoperative posterior tibial slope (group A = 10.7 ± 3.0°, group P = 7.7 ± 2.7°, p < 0.001) and posterior tibial slope change before and after surgery (group A = 1.0 ± 0.8°, group P = −0.9 ± 0.8°, p < 0.001) also differed significantly between the groups. The Pearson correlation coefficient was 0.875 (p < 0.001) for the osteotomy inclination angle, and multivariate regression analysis showed that the only significant factor among the variables was the sagittal osteotomy inclination angle (β coefficient = 0.216, p < 0.001). The posterior tibial slope changed according to the osteotomy inclination angle in the sagittal plane after MOWHTO. The postoperative posterior tibial slope tended to increase when the osteotomy line was inclined anteriorly with respect to the medial tibial plateau line but decreased when the osteotomy line was inclined posteriorly. To avoid inadvertent change of posterior tibial slope, close attention needs to be paid to maintaining the sagittal osteotomy line parallel to the medial joint line during MOWHTO.

scholarly journals Posterior tibial slope: the fingerprint of the tibial bone

2021 ◽  
Author(s):  
Philipp W. Winkler ◽  
Brian M. Godshaw ◽  
Jon Karlsson ◽  
Alan M. J. Getgood ◽  
Volker Musahl
Keyword(s):  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Tibial Bone
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