scholarly journals Medial and Lateral Posterior Tibial Slope Are Independent Risk Factors for Noncontact ACL Injury in Both Men and Women

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110159
Author(s):  
Erik Hohmann ◽  
Kevin Tetsworth ◽  
Vaida Glatt ◽  
Mthunzi Ngcelwane ◽  
Natalie Keough
Keyword(s):  
Risk Factor ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Mr Images ◽  
Men And Women ◽  
Intact Group ◽  
Posterior Tibial ◽  
Acl Deficient

Background: Higher posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) injury in men and women. The individual contribution of the lateral (LPTS) and medial (MPTS) slope has not yet been investigated. Purpose: To determine whether either the LPTS or the MPTS is an independent risk factor for ACL injury, and to determine sex-specific differences between patients with ACL-deficient and ACL-intact knees. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed knee magnetic resonance (MR) images performed on ACL-deficient and ACL-intact knees between January 2018 and June 2020 at a single institution. Inclusion criteria were isolated ACL injury and noncontact mechanism (ACL-deficient group) and nonspecific knee pain and no history of injury (ACL-intact group). Exclusion criteria for both groups were the following: previous knee surgery; meniscal, collateral ligament, posterior cruciate ligament, or multiligamentous injuries; radiological evidence of osteoarthritis; and chondral damage on the tibia. The MR images were used to establish the posterior bony slope at 25%, 50%, and 75% from the medial and/or lateral border of the tibial plateau with respect to the proximal tibial anatomic axis. One-way analysis of variance (ANOVA) was used to determine differences in PTS at the 25%, 50%, and 75% distances for the medial and lateral tibial plateau between the groups and between the sexes. Results: Overall, 325 images were included (mean age, 36.1 ± 11.1 years; 142 ACL-deficient images [82 men and 60 women]; 183 ACL-intact images [112 men and 71 women]). MPTS and LPTS were significantly higher at 25%, 50%, and 75% in the ACL-deficient group (range, –2.7° to –5.7°) compared with the ACL-intact group (range, –2.1° to 1.5°; P = .00001). Similarly, MPTS and LPTS were significantly different in men versus women ( P = .00001). ANOVA revealed that there were no significant differences in PTS between men and women for all measures (MPTS, LPTS, ACL-deficient, ACL-intact; P = .68). Conclusion: The study results demonstrated that higher MPTS and LPTS is a potential risk factor for ACL injury in both men and women. However, despite being highly statistically significant, the differences between groups and sexes were small and may not be clinically relevant.

scholarly journals Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987937 ◽  
Author(s):  
Richard J. Napier ◽  
Enrique Garcia ◽  
Brian M. Devitt ◽  
Julian A. Feller ◽  
Kate E. Webster
Keyword(s):  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Revision Acl Reconstruction ◽  
Injury Group ◽  
Anterior Cruciate

Background: Increased posterior tibial slope has been identified as a possible risk factor for injury to the anterior cruciate ligament (ACL) and has also been shown to be associated with ACL reconstruction graft failure. It is currently unknown whether increased posterior tibial slope is an additional risk factor for further injury in the context of revision ACL reconstruction. Purpose: To determine the relationship between posterior tibial slope and further ACL injury in patients who have already undergone revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 330 eligible patients who had undergone revision ACL reconstruction between January 2007 and December 2015 were identified from a clinical database. The slope of the medial and lateral tibial plateaus was measured on perioperative lateral radiographs by 2 fellowship-trained orthopaedic surgeons using a digital software application. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a minimum follow-up of 2 years (range, 2-8 years). Tibial slope measurements were compared between patients who sustained further ACL injury to either knee and those who did not. Results: There were 50 patients who sustained a third ACL injury: 24 of these injuries were to the knee that underwent revision ACL reconstruction, and 26 were to the contralateral knee. Medial and lateral slope values were significantly greater for the third-injury group compared with the no–third injury group (medial, 7.5° vs 6.3° [ P = .01]; lateral, 13.6° vs 11.9° [ P = .001]). Conclusion: Increased posterior tibial slope, as measured from lateral knee radiographs, was associated with increased risk of graft rupture and contralateral ACL injury after revision ACL reconstruction. This is consistent with the concept that increased posterior slope, particularly of the lateral tibial plateau, is an important risk factor for recurrent ACL injury.

scholarly journals Tibial slope in the posterolateral quadrant with and without ACL injury

2021 ◽  
Author(s):  
A. Korthaus ◽  
M. Krause ◽  
G. Pagenstert ◽  
M. Warncke ◽  
F. Brembach ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Knee Joint ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Mri Scans ◽  
The Mean ◽  
Anterior Cruciate

Abstract Introduction An increased tibial slope is a risk factor for rupture of the anterior cruciate ligament. In addition, a tibial bone bruise or posterior lateral impression associated with slope changes also poses chronic ligamentous instability of the knee joint associated with an anterior cruciate ligament (ACL) injury. In the majority of cases, the slope is measured in one plane X-ray in the lateral view. However, this does not sufficient represent the complex anatomy of the tibial plateau and especially for the posterolateral quadrant. Normal values from a “healthy” population are necessary to understand if stability of the knee joint is negatively affected by an increasing slope in the posterolateral area. Until now there are no data about the physiological slope in the posterolateral quadrant of the tibial plateau. Materials and methods In 116 MRI scans of patients without ligamentous lesions and 116 MRI scans with an ACL rupture, tibial slope was retrospectively determined using the method described by Hudek et al. Measurements were made in the postero-latero-lateral (PLL) and postero-latero-central (PLC) segments using the 10-segment classification. In both segments, the osseous as well as the cartilaginous slope was measured. Measurements were performed by two independent surgeons. Results In the group without ligamentous injury the mean bony PLL slope was 5.8° ± 4.8° and the cartilaginous PLL slope was 6.7° ± 4.8°. In the PLC segment the mean bony slope was 6.6° ± 5.0° and the cartilaginous slope was 9.4° ± 5.7°. In the cohort with ACL rupture, the bony and cartilaginous slope in both PLL and PCL were significantly higher (P < 0.001) than in the group without ACL injury (bony PLL 9.8° ± 4.8°, cartilage PLL 10.4° ± 4.7°, bony PLC 10.3° ± 4.8°, cartilage PLL 12.8° ± 4.3°). Measurements were performed independently by two experienced surgeons. There were good inter- (CI 87–98.7%) and good intraobserver (CI 85.8–99.6%) reliability. Conclusion The bony and the cartilaginous slope in the posterolateral quadrant of the tibial plateau are different but not independent. Patients with an anterior cruciate ligament injury have a significantly steeper slope in the posterolateral quadrant compared to a healthy group. Our data indicate that this anatomic feature might be a risk factor for a primary ACL injury which has not been described yet. Level of evidence III.

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

Age-Related Changes of Posterior Tibial Slope and Its Roles in Anterior Cruciate Ligament Injury

2016 ◽  
Vol 101 (1-2) ◽  
pp. 70-77 ◽  
Author(s):  
Ying-hua Sun ◽  
Lian-xu Chen ◽  
Zhao-de Jiao ◽  
Li Wang ◽  
Rui-ming Zhang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Curve Fitting ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Age Related ◽  
Anterior Cruciate ◽  
Age Related Changes

Nearly all previous studies in posterior tibial slope (PTS) and anterior cruciate ligament (ACL) injuries ignored age-related changes, and the published data are inconsistent. The objective of this study was to reveal age-related changes of PTS and its roles in ACL injury. Data for 2618 lower limbs were included initially based on the availability of lateral X-rays and a suitable femorotibial angle. The final 1431 subjects were analyzed according to age, sex, side, and injury status. Student t-tests, 1-way analysis of variance, and curve fitting were used to analyze data. The PTS in males was greater than that in females in the 0–9 and 30–39-year-old groups, but this pattern was reversed in the 40–49, 60–69, 70–79, and 80–89-year-old groups. The PTS was greater on the left side than on the right side in the 0–9, 10–19, 50–59, 60–69, and 80–89-year-old groups. The curve fitting for PTS demonstrated a trend of first decreasing and then increasing with aging. The PTS values differed significantly between knees with an ACL injury and those without in the 20–29, 30–39, and 40–49-year-old groups but not in the 50–59-year-old group. The PTS follows a trend of first decreasing and then increasing, and its role in ACL injury changes with advancing age. The higher PTS is only unrelated to the risk of ACL injury in age groups with a lower mean PTS value.

scholarly journals Radiographic evaluation of posterior tibial slope in ACL deficient Indian patients

2019 ◽  
Vol 5 (3) ◽  
pp. 473
Author(s):  
Ravi Kumar ◽  
Kishore Kunal
Keyword(s):  
Standard Deviation ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Notch Width ◽  
Indian Patients ◽  
History Of ◽  
The Mean ◽  
Acl Deficient

<p class="abstract"><strong>Background:</strong> There are several studies which have investigated various osseous morphologic characteristics as they relate to ACL injury. Tibial slope, notch width, and notch width index are some. However, there does not appear to be consensus across studies. The aim of this study was to validate association between posterior tibial slope (PTS) and ACL injury in an ACL deficient knee of Indian patients.</p><p class="abstract"><strong>Methods:</strong> This retrospective cum prospective study was done at a tertiary hospital from June 2017 to May 2018. 40 patients were included. Inclusion criteria were documented evidence of ACL tear to the affected knee; no history of osteoarthritis; no history of rheumatoid arthritis; patients voluntarily consented for the use of their radiographs for the study. The assessment was completed with a true lateral view of the knee with full length leg and ankle. The functional tibial slope as described by Julliard et al was used to determine the PTS. The mean and standard deviation (SD) for medial PTS were measured. Demographic data like age, sex were collected and entered into a database.<strong></strong></p><p class="abstract"><strong>Results:</strong> 95% of patients were male. Mean age was 29.25. The mean PTS was 13.037 which is reasonably high as compared to normal while the standard deviation was 4.487 reflecting large amount of variation.</p><p><strong>Conclusions:</strong> Increased posterior tibial slope can be concluded as a significant risk factor in ACL injury which corroborates the findings of various previously published studies. The findings presented may help identify patients who are at greater risk of ACL injury. </p>

Introducing the Lateral Femoral Condyle Index as a Risk Factor for Anterior Cruciate Ligament Injury

2019 ◽  
Vol 47 (10) ◽  
pp. 2420-2426 ◽  
Author(s):  
Sandro Hodel ◽  
Method Kabelitz ◽  
Timo Tondelli ◽  
Lazaros Vlachopoulos ◽  
Reto Sutter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Area Under The Curve ◽  
Acl Injury ◽  
Tibial Slope ◽  
Acl Rupture ◽  
Control Group ◽  
Predictive Risk

Background: The asymmetry of the medial and lateral knee compartments contributes significantly to femorotibial biomechanics and pivoting, and it is reported to be a relevant risk factor for an anterior cruciate ligament (ACL) injury. Purpose: (1) To assess the role of femoral condyle sphericity as a risk factor for an ACL rupture and rerupture. (2) To compare the new risk factor with existing bony morphological risk factors via magnetic resonance imaging (MRI) and to assess the most predictive risk factor for an ACL rupture. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective case-control study of 60 patients was conducted. Three age- and sex-matched cohorts (each n = 20) were analyzed: ACL reruptures, primary ACL ruptures, and a control group consisting of isolated meniscal tears or patients with anterior knee pain without signs of trochlear dysplasia. The lateral femoral condyle index (LFCI) as a novel MRI measurement was developed to quantify femoral sphericity. In addition, previously known MRI risk factors associated with ACL injury were analyzed (notch width index, medial tibial slope, lateral tibial slope, medial tibial depth, and lateral tibial height). Differences among groups were compared; cutoff values were defined; and diagnostic performance of the risk factors was assessed. The risk factors were subsequently analyzed with multiple logistic regression. Results: The LFCI was significantly smaller in knees with ACL reruptures (median, 0.67; range, 0.59-0.75) and primary ACL ruptures (0.67; range, 0.60-0.75) than in the control group (0.76; range, 0.6-0.81; P < .01). The LFCI yielded the highest area under the curve among the analyzed risk factors: 0.82 (95% CI, 0.7-0.9). A cutoff of 0.70 yielded a sensitivity of 78% and a specificity of 80% to predict an ACL rupture or rerupture (odds ratio, 13.79; 95% CI, 3.67-51.75). In combination with lateral tibial height (cutoff, 3.8 mm) and lateral tibial slope (cutoff, 2.9°), the diagnostic performance was improved. The area under the curve was 0.86 (95% CI, 0.75-0.94), with a sensitivity of 90% and a specificity of 70% (odds ratio, 21.00; 95% CI, 5.10-85.80). Conclusion: A decreased LFCI is associated with an ACL injury. The LFCI, lateral tibial height, and lateral tibial slope are the most predictive risk factors for an ACL injury. These findings might aid clinicians in identifying patients at risk for an ACL injury and inform the patient after reconstruction for a higher risk of rerupture.

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]

Coronal Lateral Collateral Ligament Sign: A Novel Magnetic Resonance Imaging Sign for Identifying Anterior Cruciate Ligament–Deficient Knees in Adolescents and Summarizing the Extent of Anterior Tibial Translation and Femorotibial Internal Rotation

2021 ◽  
Vol 49 (4) ◽  
pp. 928-934
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Tracey Bastrom ◽  
James D. Bomar ◽  
Andrew T. Pennock ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Internal Rotation ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Anterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Acl Deficient

Background: Incompetence of the anterior cruciate ligament (ACL) confers knee laxity in the sagittal and axial planes that is measurable with clinical examination and diagnostic imaging. Hypothesis: An ACL-deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on magnetic resonance imaging. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Charts were retrospectively reviewed from April 2009 to December 2017 for all patients treated with ACL reconstruction (constituting the ACL-deficient cohort). A control cohort was separately identified consisting of patients with a normal ACL and no pathology involving the collateral ligaments or posterior cruciate ligament. Patients were excluded for follow-up <2 years, incomplete imaging, and age >19 years. Tibial translation and femorotibial rotation were measured on magnetic resonance images, and posterior tibial slope was measured on a lateral radiograph of the knee. Imaging was reviewed for the presence of the coronal LCL sign. Results: The 153 patients included in the ACL-deficient cohort had significantly greater displacement than the 70 control patients regarding anterior translation (5.8 vs 0.3 mm, respectively; P < .001) and internal rotation (5.2° vs −2.4°, P < .001). Posterior tibial slope was not significantly different. The coronal LCL sign was present in a greater percentage of ACL-deficient knees than intact ACL controls (68.6% vs 18.6%, P < .001). The presence of the coronal LCL sign was associated with greater anterior tibial translation (7.2 vs 0.2 mm, P < .001) and internal tibial rotation (7.5° vs –2.4°, P = .074) but not posterior tibial slope (7.9° vs 7.9°, P = .973) as compared with its absence. Multivariate analysis revealed that the coronal LCL sign was significantly associated with an ACL tear (odds ratio, 12.8; P < .001). Conclusion: Our study provides further evidence that there is significantly more anterior translation and internal rotation of the tibia in the ACL-deficient knee and proves our hypothesis that the coronal LCL sign correlates with the presence of an ACL tear. This coronal LCL sign may be of utility for identifying ACL tears and anticipating the extent of axial and sagittal deformity.

Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Analysis of Subsequent ACL Graft Tear or Contralateral ACL Tear

2021 ◽  
Vol 49 (3) ◽  
pp. 620-625
Author(s):  
K. Donald Shelbourne ◽  
Rodney W. Benner ◽  
Jonathan A. Jones ◽  
Tinker Gray
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Reports on greater posterior tibial slope (PTS) and its relationship to subsequent anterior cruciate ligament (ACL) injury show conflicting results; it has not been studied much in patients after ACL reconstruction with patellar tendon autograft (PTG). Hypothesis: Patients who suffered a subsequent ACL injury would have a larger PTS than patients who did not suffer a subsequent injury after primary or revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients received primary (n = 2439) or revision (n = 324) ACL reconstruction with PTG and were followed prospectively to determine the rate of graft tear and contralateral ACL tear. The PTS was measured preoperatively on digital lateral view radiographs. Intersecting lines were drawn along the medial tibial plateau and posterior tibia; the value of the acute angle at the lines’ intersection was then subtracted from 90° to obtain the PTS. This procedure was completed by a clinical assistant with an intrarater reliability of 0.89. Chi-square analysis and t tests were used to determine the differences between rate of tears and measurements between groups. A threshold of PTS ≥10° was used for analysis. Results: The mean follow-up time was 11.6 ± 4.0 years. After primary surgery, the mean PTS in patients with graft tears was 5.4°± 3.1° versus 4.8°± 2.9° for patients without a tear ( P = .041). The mean PTS was 4.9°± 3.4° for patients with contralateral tears (not statistically significantly different than the no-tear group; P = .80). Furthermore, patients with primary reconstruction with PTS ≥10° had a statistically significantly higher rate of graft tear (9.7%) than patients with PTS ≤9° (4.8%) ( P = .003), but not a higher rate of contralateral tear. Among patients undergoing revision surgery, there were no statistically significant differences between the graft tear, contralateral tear, and no-tear groups with relation to PTS ≥10°. Conclusion: After primary ACL reconstruction, patients with PTS >10° had a higher rate of subsequent graft tear but not a higher rate of contralateral tear. With revision surgery, there was no significant association between PTS and the rate of subsequent tear. Therefore, caution should be exercised when considering more radical interventions, such as osteotomy, to prevent retear in patients with high PTS.

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