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

2020 ◽  
Author(s):  
Ning Fan ◽  
Yong-chen Zheng ◽  
Lei Zang ◽  
Cheng-gang Yang ◽  
Shuo Yuan ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Binary Logistic Regression ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Notch Width ◽  
Lateral Posterior ◽  
The Impact ◽  
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 and determine risk factors in men and women separately. Methods A retrospective case-control study of 48 patients (comprised 25 men and 23 women) with PCL avulsion fracture compared with 48 age- and sex-matched controls was performed from 2012 to 2018. MRI measurements of the knee were acquired in the sagittal, coronal, and axial sequences. The assessed measurements including intercondylar notch width index, medial/lateral posterior tibial slopes, and coronal tibial slope were compared between case and control groups in both women and men. Univariable and binary logistic regression analyses were used to identify independent risk factors that were associated with PCL avulsion fracture. Results When female patients were analyzed, the notch width index (coronal) was significantly smaller, and the lateral posterior tibial slope was significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.307, OR = 0.735, p = 0.025) was found to be an independent factor. When male patients were analyzed, no radiographic parameter was found to have a statistical difference between the case and control groups. Conclusions Notch width index (coronal) 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 Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

2019 ◽  
Vol 47 (2) ◽  
pp. 312-317 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Nicholas N. DePhillipo ◽  
Blake T. Daney ◽  
Mitchell I. Kennedy ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Ligament Injury ◽  
Mechanism Of Injury ◽  
Control Groups ◽  
Pcl Reconstruction ◽  
Posterior Tibial ◽  
Pcl Injury ◽  
Age And Sex

Background: Recent biomechanical studies have identified sagittal plane posterior tibial slope as a potential risk factor for posterior cruciate ligament (PCL) injury because of its effects on the kinematics of the native and surgically treated knee. However, the literature lacks clinical correlation between primary PCL injuries and decreased posterior tibial slope. Purpose/Hypothesis: The purpose of this study was to retrospectively compare the amount of posterior tibial slope between patients with PCL injuries and age/sex-matched controls with intact PCLs. It was hypothesized that patients with PCL injuries would have a significantly decreased amount of posterior tibial slope when compared with patients without PCL injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent primary PCL reconstruction without anterior cruciate ligament injury between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed with lateral radiographs of PCL-injured knees and matched controls without clinical or magnetic resonance imaging evidence of ligamentous injury. Mean values of posterior tibial slope were compared between the groups. Inter- and intrarater agreement was assessed for the tibial slope measurement technique via a 2-way random effects model to calculate the intraclass correlation coefficient (ICC). Results: In sum, 104 patients with PCL tears met the inclusion criteria, and 104 controls were matched according to age and sex. There were no significant differences in age ( P = .166), sex ( P = .345), or body mass index ( P = .424) between the PCL-injured and control groups. Of the PCL tear cohort, 91 patients (87.5%) sustained a contact mechanism of injury, while 13 (12.5%) reported a noncontact mechanism of injury. The mean ± SD posterior tibial slopes were 5.7°± 2.1° (95% CI, 5.3°-6.1°) and 8.6°± 2.2° (95% CI, 8.1°-9.0°) for the PCL-injured and matched control groups, respectively ( P < .0001). Subgroup analysis of the PCL-injured knees according to mechanism of injury demonstrated significant differences in posterior tibial slope between noncontact (4.6°± 1.8°) and contact (6.2°± 2.2°) injuries for all patients with PCL tears ( P = .013) and among patients with isolated PCL tears ( P = .003). The tibial slope measurement technique was highly reliable, with an ICC of 0.852 for interrater reliability and an ICC of 0.872 for intrarater reliability. Conclusion: A decreased posterior tibial slope was associated with patients with PCL tears as compared with age- and sex-matched controls with intact PCLs. Decreased tibial slope appears to be a risk factor for primary PCL injury. However, further clinical research is needed to assess if decreased posterior tibial slope affects posterior knee stability and outcomes after PCL reconstruction.

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

Increased Posterior Tibial Slope in Patients With Osgood-Schlatter Disease: A New Association

2020 ◽  
Vol 48 (3) ◽  
pp. 642-646
Author(s):  
Daniel W. Green ◽  
Sreetha Sidharthan ◽  
Lindsay M. Schlichte ◽  
Alexandra H. Aitchison ◽  
Douglas N. Mintz
Keyword(s):  
Patellar Tendon ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Tibial Slope ◽  
Lateral Radiograph ◽  
Posterior Tibial Slope ◽  
Control Group ◽  
Posterior Tibial ◽  
The Mean ◽  
And Control

Background: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle caused by repetitive strain and chronic avulsion from the patellar tendon. No widely accepted anatomic risk factors have been associated with OSD. Purpose: To determine if OSD is associated with increased posterior tibial slope (PTS). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients 10 to 15 years of age with a clinical diagnosis of OSD and available lateral radiograph and magnetic resonance imaging (MRI) were eligible. Age- and sex-matched patients with a history of knee pain but no evidence of OSD on clinical examination and without significant pathology on lateral radiograph and MRI were included in the control group. PTS was defined as the angle between a reference line perpendicular to the proximal anatomic axis and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral radiographs by 2 blinded investigators. Interrater reliability of PTS measurements was evaluated using intraclass correlation coefficient (ICC). The independent samples t test was used to compare PTS between the OSD and control knees. Results: The mean age was 12.6 ± 1.6 years and 51% (37/72) of the knees were from male youth. There were no differences in age, sex, and laterality of knees between the OSD and control groups. The mean PTS was significantly higher in the OSD group (12.23°± 3.58°) compared with the control group (8.82°± 2.76°; P < .001). The ICC was 0.931 (95% CI, 0.890-0.957), indicating almost perfect interrater reliability. Conclusion: This study identifies an association between OSD and increased PTS. The clinical implications of this finding have not yet been elucidated. It may be speculated that in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.

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.

Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up

2021 ◽  
pp. 036354652199709
Author(s):  
R. Kyle Martin ◽  
Guri R. Ekås ◽  
JūratėŠaltytė Benth ◽  
Nicholas Kennedy ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Skeletally Immature ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean ◽  
Injured Knee

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° ( P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° ( P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° ( P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.

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>

scholarly journals IS OSGOOD-SCHLATTER DISEASE TRULY A BENIGN KNEE CONDITION? A PILOT STUDY DEMONSTRATING INCREASED POSTERIOR TIBIAL SLOPE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Daniel W. Green ◽  
Sreetha Sidharthan ◽  
Lindsay M. Schlichte
Keyword(s):  
Patellar Tendon ◽  
Interrater Reliability ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Ossification Center ◽  
Control Group ◽  
X Rays ◽  
X Ray ◽  
Posterior Tibial ◽  
And Control

Background: Osgood-Schlatter disease (OSD) is a traction apophysitis caused by repetitive strain and chronic avulsion of the secondary ossification center of the tibal tuberosity from the patellar tendon. Purpose: The aim of this study was to determine if OSD is associated with increased posterior tibial slope (PTS). Methods: A total of 40 knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients aged 10 to 15 years old with clinical diagnosis of OSD supported by radiographic findings on lateral X-ray and MRI were eligible. Age- and sex-matched subjects with history of anterior knee pain but no evidence of OSD on clinical exam and no fragmentation of the tibial tubercle on lateral X-Ray and MRI were included in the control group. PTS was defined as the angle between the reference line and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral X-Rays by two blinded investigators. Interrater reliability of posterior tibial slope measurements between the two examiners was evaluated using intraclass correlation coefficient (ICC). Independent-sample student t-test was used to compare PTS in the OSD and control knees. Results: Mean age at time of lateral radiograph was 12.6 ± 1.6 years and 51% (37/72) of knees were male. There were no differences in age, sex, and laterality of knees between the OSD and control groups. Mean PTS was significantly higher in the OSD group (12.23º ± 3.58º) compared to the control group (8.82 º ± 2.76 º, p<0.001) (Figure 1). ICC was 0.931 (95% confidence interval, 0.890 to 0.957) for measurement of PTS between the two examiners, indicating almost perfect interrater reliability. Conclusion: This study is the first to identify an association between OSD and increased PTS. The clinical implications of this novel finding have not yet been elucidated. However, several studies have demonstrated that increased PTS is a risk factor for ACL injury and re-tear. It may be speculated in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS. [Figure: see text]

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.

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