Measurement of Posterior Tibial Slope in Turkish Population Groups with Magnetic Resonance İmaging

Abstract Background The posterior tibial slope (PTS) has great importance on the balance and the stability of the knee and has to be taken into account during the reconstruction and replacement procedure. However, the anthropometric measurements are not universal and show population-based variations. The purpose of this study is to find features of PTS in the Turkish population in regards to the medial and lateral compartment. Methods Magnetic resonance images (MRIs) were retrieved from the Picture Archiving and Communication System (PACS). Subjects from 25 to 45 years old were included from the MRIs taken between July 2015 to July 2017. Any MRI with radiological signs of osteoarthritis, chondral and meniscus (grade 3 & 4) lesions was excluded as well as a deformity in the lower extremity, patients with a history of fracture and/or history of knee surgery. The measurements were made using T1-weighted coronal and sagittal MRI planes with a slice thickness of 4 mm. The PTS of the medial, lateral plateau were recorded with gender and age of the subjects. Non-parametric Spearman's Correlation tests and Student T tests were used to calculate the relationship between medial-lateral PTS and ages and also to evaluate PTS differences between genders. Results Two-hundred thirty-two subjects (122 female, 110 male) were included in the study. The mean medial and lateral PTS were 7.7°±1.3° and 7.5°±1.3° respectively, and there was a significant correlation (p < 0.001). However, no significant difference was found in the mean medial PTS (p = 0.45) and lateral PTS (p = 0.73) between genders and matched age groups. Conclusions Our results showed that there is no gender-based variation in the Turkish population. Although we do not make a systematic comparison, the measurements of PTS in the Turkish population were different from other populations.

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

Vojnosanitetski pregled ◽

10.2298/vsp160301203j ◽

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.

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Radiographic evaluation of posterior tibial slope in ACL deficient Indian patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191787 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1729967 ◽

2021 ◽

Author(s):

O-Sung Lee ◽

Jangyun Lee ◽

Myung Chul Lee ◽

Hyuk-Soo Han

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Correlation Coefficient ◽

Knee Arthroplasty ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Clinical Scores ◽

Total Knee ◽

The Mean

AbstractThe posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA,

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Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04367-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Liangxiao Bao ◽

Shengwei Rong ◽

Zhanjun Shi ◽

Jian Wang ◽

Yang Zhang

Keyword(s):

Three Dimensional ◽

Surgical Techniques ◽

Inverse Correlation ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Lateral Side ◽

Posterior Condylar Offset ◽

Posterior Tibial ◽

Significant Difference ◽

Posterior Condylar

Abstract Background Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. Methods Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. Results PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P < 0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. Conclusions Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.

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Ángulo de pendiente tibial posterior “Slope” en prótesis total de rodilla. Diferencias entre alineación Intra o Extramedular y su repercusión sobre el rango de movilidad postoperatorio.

Revista Española de Cirugía Osteoarticular ◽

10.37315/sotocav201928054143 ◽

2019 ◽

pp. 143-148

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Slope Angle ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Slope ◽

Posterior Tibial ◽

Total Knee ◽

The Mean ◽

Posterior Slope Angle

Introduction: The aim of this work was to compare the posterior tibial slope of the tibial component after performing a total knee arthroplasty, as an intramedullary or extramedullary guide was used during the surgical technique, as well as comparing the range of mobility obtained according to the Instrumentation used. Material and methods: We conducted a descriptive, retrospective, observational study of a series of 57 patients operated in our Center during 2012 and 2013, with the same model of total knee arthroplasty (Sigma PS® DePuy), divided into two homogeneous groups in terms of age, sex, degree of osteoarthritis evolution, the first with patients operated by extramedullary guidance and the second by intramedullary guidance. A radiographic study was performed, measuring the posterior slope angle in the sagittal plane. The range of mobility achieved after arthroplasty and implant survival was studied. Results: Together, in both groups, measurements of the posterior slope angle were made, which was 4.35º preoperative average. In groups, the mean postoperative posterior fall angle was 4.04 ° in the patients who underwent an EM guide, while those who underwent an IM guide the mean was 1.76 °; the differences being statistically significant. The range of mobility in the ATRs operated by intramedullary guidance was 102.7º on average (range 80-125º), while in the group where the extramedullary guide was used, it was 104.3º (range 80-130º) no these differences being statistically significant. Regarding the survival of the implant, during the study period two cases of patients undergoing surgery for the replacement of prostheses were found, both of which belonged to the “Extramedullary guide” group. Conclusion: The posterior drop angle, for the same PS prosthesis model, was statistically different according to the guide used, being within the 3-7º range in the group where the extramedullary guide was used; but despite these differences, no impact on the range of mobility was observed. Currently, it is recommended to restore the patient's posterior tibial slope, and in cases with a slope greater than 10º use a PS ATR.

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

The American Journal of Sports Medicine ◽

10.1177/0363546519899894 ◽

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.

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Posterior tibial slope of the knee measured on X-rays in a Turkish population

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02430-w ◽

2020 ◽

Vol 42 (6) ◽

pp. 673-679

Author(s):

Ismail Eralp Kacmaz ◽

Yuksel Topkaya ◽

Can Doruk Basa ◽

Vadym Zhamilov ◽

Ali Er ◽

...

Keyword(s):

Tibial Slope ◽

Turkish Population ◽

Posterior Tibial Slope ◽

X Rays ◽

Posterior Tibial

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

The Journal of Knee Surgery ◽

10.1055/s-0041-1740384 ◽

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546516662449 ◽

2016 ◽

Vol 45 (1) ◽

pp. 106-113 ◽

Cited By ~ 34

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546521997097 ◽

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.

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