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

2020 ◽  
Author(s):  
Musab Ümeyir Karakanlı ◽  
Ferdanur Deniz ◽  
İlkin Celilov ◽  
Ömer Sofulu ◽  
Fatih Küçükdurmaz
Keyword(s):  
Magnetic Resonance ◽  
Tibial Slope ◽  
Turkish Population ◽  
Magnetic Resonance Images ◽  
Posterior Tibial Slope ◽  
Slice Thickness ◽  
Posterior Tibial ◽  
Significant Difference ◽  
History Of ◽  
The Mean

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.

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

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.

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.

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.

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]

scholarly journals The relationship between posterior tibial slope and anterior cruciate ligament injury

2014 ◽  
Vol 67 (7-8) ◽  
pp. 216-221 ◽  
Author(s):  
Vladimir Ristic ◽  
Mirsad Maljanovic ◽  
Branislav Pericin ◽  
Vladimir Harhaji ◽  
Miroslav Milankov
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Anterior Cruciate Ligament Rupture ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Anterior Cruciate

Introduction. The aim of this study was to identify an increased posterior tibial slope as a possible risk factor for anterior cruciate ligament injury. Material and Methods. Sixty patients were divided into two groups (with and without anterior cruciate ligament rupture). The posterior tibial slope on the lateral and medial condyles was measured by sagittal magnetic resonance imaging slices by means of computerized method using circles to determine tibial axis. Results. The patients with anterior cruciate ligament rupture had a statistically significantly (p=0.06) greater posterior tibial slope on the lateral tibial condyle than the control group (6.68?:5.64?), and a greater slope on the medial condyle (5.49?:4.67?) in comparison to the patients with the intact anterior cruciate ligament. No significant difference in the average values of angles was observed between males and females with anterior cruciate ligament rupture, the average value being 6.23? in men and 5.84? in women on the lateral condyle, and 4.53? in men and 4.53? in women on the medial condyle. Discussion and Conclusion. A statistically significant difference between the values of posterior tibial slope was observed between the groups with and without anterior cruciate ligament rupture, the sex having no affect on the value of the posterior tibial slope. The method of measuring angles should be unique.

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.

High Varus Angle and Lower Posterior Tibial Slope Associated with PCL Injury in Cruciate Retaining Total Knee Arthroplasty: An MRI Study

2017 ◽  
Vol 31 (03) ◽  
pp. 277-283 ◽  
Author(s):  
Yunus İmren ◽  
Ali Tekin ◽  
Süleyman Dedeoğlu ◽  
Hakan Gürbüz ◽  
Haluk Çabuk
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Slope ◽  
Magnetic Resonance Images ◽  
Posterior Tibial Slope ◽  
Varus Alignment ◽  
Cruciate Retaining ◽  
Posterior Tibial ◽  
Tibial Cut ◽  
Total Knee

AbstractThe posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X-rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0-degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.

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