Decreased Posterior Tibial Slope Does Not Affect Postoperative Posterior Knee Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction

Bernhardson, Andrew S.; DePhillipo, Nicholas N.; Aman, Zachary S.; Kennedy, Mitchell I.; Dornan, Grant J.; LaPrade, Robert F.

doi:10.1177/0363546518819786

Cited by 26 publications

(26 citation statements)

References 23 publications

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“…9,33 Despite the findings from the current study and the supporting literature that lateral PTS likely has a greater effect on overall ACL strain than does medial PTS, several studies have shown that severe inclinations at either plateau can significantly affect overall ACL strain and that both the medial and lateral PTS likely affect ACL stability. 9,67 The current meta-analysis also provides accurate, updated normative values for 3 distinct cohorts based on ACL integrity: intact ACL, primary ACL tear, and failed ACLR. Specifically, for knee surgeons and sports medicine researchers, PTS is a growing area of interest and clinicians/researchers are often forced to reference larger case series when attempting to identify the average PTS of patients.…”

Section: Discussioncontrasting

confidence: 89%

Posterior Tibial Slope in Patients With Torn ACL Reconstruction Grafts Compared With Primary Tear or Native ACL: A Systematic Review and Meta-analysis

Dean

DePhillipo

LaPrade

2022

Orthopaedic Journal of Sports Medicine

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Background: Increased posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) rupture and failure of ACL reconstruction (ACLR) grafts. Purpose: The purpose was to conduct a systematic review of literature on PTS measurements and to conduct a meta-analysis of comparable PTS measurements based on a patient’s ACL status. It was hypothesized that patients with torn ACLR grafts would have significantly larger medial and lateral PTS compared with patients with native ACLs or those who underwent primary ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that reported medial and/or lateral PTS measurements, those that reported PTS measurements based on ACL status (ie, intact ACL, primary ACL tear, failed ipsilateral ACLR, or revision ACLR), and those that reported their specific PTS measurement technique. Average PTS measurements, measurement location (medial or lateral tibial plateau) and technique, imaging modality used, and ACL status were extracted from each study. Data were pooled using DerSimonian and Laird random-effects models, and results were compared using the Altman interaction test. Results: The literature search identified 1705 studies, of which 82 (N = 12,971 patients) were included. There were 4028 patients in the intact ACL group (31%), 7405 in the primary ACLR group (57%), and 1538 in the failed ACLR group (12%). Measurements were obtained from lateral radiographs in 31 studies (38%), from magnetic resonance imaging in 47 studies (57%), and from computed tomography in 4 studies (5%). The failed ACLR group had a significantly larger lateral PTS (9.55°; 95% CI, 8.47°-10.63°) than either the primary ACL tear (7.13°; 95% CI, 6.58°-7.67°) or intact ACL (5.57°; 95% CI, 5.03°-6.11°) groups ( P < .001 for both). The failed ACLR group also had a significantly larger medial PTS (9.05°; 95% CI, 7.80°-10.30°) than the primary (6.24°; 95% CI, 5.71°-6.78°) or intact ACL (6.28°; 95% CI, 5.21°-7.35°) groups ( P < .001 for both). Conclusion: Both lateral and medial PTS measurements were greater in patients who had failed previous ACLR than those with a primary ACL tear or an intact native ACL. The lateral PTS of patients with primary ACL tears was greater than those with an intact native ACL.

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Section: Discussioncontrasting

confidence: 89%

Posterior Tibial Slope in Patients With Torn ACL Reconstruction Grafts Compared With Primary Tear or Native ACL: A Systematic Review and Meta-analysis

Dean

DePhillipo

LaPrade

2022

Orthopaedic Journal of Sports Medicine

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“…In the first of these, 3 the authors report that the posterior tibial slope in 104 PCL-injured knees averaged almost 3° less than that in a matched group of controls without ligament injury. In the second study, 2 the authors examine the results of PCL reconstruction through the lens of tibial slope. They report that their double-bundle technique successfully reduced the mean side-to-side difference in posterior tibial translation from 10.6 to 1.5 mm as measured in stress radiographs obtained 18.5 months after surgery.…”

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confidence: 99%

Slippery Slope

Reider¹

2019

Am J Sports Med

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“…Biomechanical studies have shown that a decrease in the posterior tibial slope can increase the PCL graft force 4 and the PTT in the PCL-deficient knee under a posterior drawer. 10 , 34 However, it is controversial in clinical settings; Bernhardson et al 5 demonstrated that the postoperative PTT was not influenced by a decreased posterior tibial slope after double-bundle PCLR at 18.5 months postoperatively. Conversely, in a single linear regression analysis after single-bundle PCLR, Gwinner et al 12 showed that the flattening of the posterior tibial slope was associated with a significantly greater persistent PTT at a longer follow-up point of 103 months, where sex and the number of operated ligaments were not considered.…”

Section: Discussionmentioning

confidence: 99%

“…The mean posterior tibial slope in the current study was 6.8° ± 2.3° (range, 3.0°-13.0°) and was pretty much average compared with the previous data (from 5.9° to 8.0°). 5 , 12 This could indicate that only extreme flattening of the posterior tibial slope affected the PTT. However, future studies might be warranted to investigate the effect of the posterior tibial slope after double-bundle PCLR with a longer follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

Tachibana

Tanaka

Kinugasa

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Residual posterior sagging may occur after posterior cruciate ligament (PCL) reconstruction (PCLR), yet when it mainly occurs is not fully understood. Purpose: To elucidate sequential changes in radiographic posterior tibial translation (PTT) after PCLR. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively investigated the radiographic findings from 22 patients who underwent bisocket double-bundle PCLR for isolated PCL injury with at least 2 years of follow-up (mean, 4.5 years; range, 2-10 years). Injury severity was assessed using PTT on lateral radiographs with gravity sag views and was stratified according to side-to-side difference in the tibial-femoral stepoff: grade 1 (<5 mm), grade 2 (5 to <10 mm), or grade 3 (≥10 mm). Measurements were taken preoperatively and then immediately, 3 months, 6 months, 1 year, and ≥2 years postoperatively. The authors also investigated the risk factors for residual posterior sagging, indicated when PTT was ≥5 mm (grade ≥2) at the minimum 2-year follow-up. Results: Preoperatively, 13 patients had a grade 2 injury, and 9 had grade 3 injury. The PTT, restored immediately after PCLR, significantly increased at 3 months ( P < .001) but remained unchanged thereafter ≥2 years. There were 7 cases of postoperative PTT ≥5 mm on radiographs. Patients with residual posterior sagging had significantly larger mean PTT than did those without residual posterior sagging at all time points except for immediately postoperatively (preoperatively, 9.1 ± 1.6 vs 12.2 ± 2.3 mm; 3-month follow-up, 2.7 ± 1.6 vs 7.0 ± 1.8 mm; ≥2-year follow-up, 3.4 ± 1.0 vs 6.5 ± 1.4 mm; P < .001 for all). Multivariate logistic regression analysis showed that preoperative grade 3 injury was independently associated with residual posterior sagging (OR, 26.809; 95% CI, 1.257-571.963; P < .001). Conclusion: The initially reduced postoperative PTT significantly increased within 3 months using conventional rehabilitation protocols, but no progression was observed up to 4.5 years after PCLR. Preoperative grade 3 injury was independently associated with residual posterior sagging.

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Decreased Posterior Tibial Slope Does Not Affect Postoperative Posterior Knee Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction

Cited by 26 publications

References 23 publications

Posterior Tibial Slope in Patients With Torn ACL Reconstruction Grafts Compared With Primary Tear or Native ACL: A Systematic Review and Meta-analysis

Posterior Tibial Slope in Patients With Torn ACL Reconstruction Grafts Compared With Primary Tear or Native ACL: A Systematic Review and Meta-analysis

Slippery Slope

Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

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