Four to 6° Is the Target Posterior Tibial Slope After Tibial Deflection Osteotomy According to the Knee Static Anterior Tibial Translation

Dan, Michael J.; Cance, Nicolas; Pineda, Tomás; Demey, Guillaume; Dejour, David

doi:10.1016/j.arthro.2023.07.007

Cited by 15 publications

(7 citation statements)

References 37 publications

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“…Although excellent results have been observed by surgically reducing PTS, the postoperative PTS correction goal is highly variable in the literature and is not based on an objective parameter. 1,11,26,33 Dan et al 6 recently proposed a 4° to 6° residual slope after TDO, as lower values of slope were associated with a negative SATT. 12 Nevertheless, this previous normal value has some limitations, as we mentioned before.…”

Section: Discussionmentioning

confidence: 99%

“…SATT has recently been proposed as an adjunct to PTS for planning tibial deflection osteotomy (TDO) in patients who are undergoing revision ACLR with increased PTS. 10,11,26 Dan et al 6 analyzed the results of 48 TDOs and changed the suggested target tibial slope to 4° to 6°, as the previous target of 2° to 3° tibial slope resulted in a negative SATT value. Nevertheless, this normal value of SATT has not yet been well defined in the literature.…”

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confidence: 99%

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Radiographic Investigation of Differences in Static Anterior Tibial Translation With Axial Load Between Isolated ACL Injury and Controls

Cance,

Dan,

Pineda

et al. 2024

Am J Sports Med

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Background: Static anterior tibial translation (SATT) is radiographically measured to show the amount of tibial translation during the single-leg stance, and thus it is representative of the physiological axial load subjected to the anterior cruciate ligament (ACL) during the stance. Increased SATT has been associated with increased posterior tibial slope (PTS) and is also associated with increased graft failure. Purpose: To compare the SATT value in a control population with that in a population with an isolated ACL injury, as well as to compare the effect of tibial slope on SATT between the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive series of patients without ligamentous or meniscal injuries between 2019 and 2022 was reviewed. A matched consecutive cohort of patients with nonacute ACL injuries (surgery between 6 and 12 weeks after injury) without concomitant pathology was reviewed. Preoperative SATT and PTS were measured with a previously validated technique on lateral weightbearing knee radiographs. The SATT value was determined, and regression analysis was performed to investigate the relationship between SATT and PTS. Results: In total, 101 controls and 115 patients with an ACL injury were included in this study. The mean SATT was 1.31 mm (SD, 2.44 mm) and the mean PTS was 10.61° (SD, 3.28°) in the control cohort. The SATT was larger (mean, 2.27 mm; SD, 3.36 mm) in the ACL-injured cohort despite the tibial slope measurement being less in the ACL-injured cohort (mean, 9.46°; SD, 2.85°; P = .016). Linear regression analysis showed that for every 1° of increase in PTS, there was a 0.34-mm increase in SATT in the control cohort; however, there was a greater increase of 0.5 mm for every 1° of increase in PTS in the ACL-injured cohort. We found no significant differences in SATT when the cohorts were compared by age ( P = .26) or sex ( P = .10). Conclusion: The present study reports a reference SATT value of 1.31 mm (SD, 2.44 mm) in a non–ACL-injured cohort, which was lower than in the ACL-injured cohort (mean, 2.27 mm; SD, 3.36 mm). The effect of slope on weightbearing anterior tibial translation was greater in the ACL-injured population than in the control cohort.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Radiographic Investigation of Differences in Static Anterior Tibial Translation With Axial Load Between Isolated ACL Injury and Controls

Cance,

Dan,

Pineda

et al. 2024

Am J Sports Med

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“…Static anterior tibial translation is a radiographically validated measurement method for quantifying anterior tibial translation during the single-leg stance and is representative of the physiological axial load seen by the ACL during the single-leg stance. 5 The surgical technique has been described previously 8,19 (Figure 1). After an examination under anesthesia, the leg was prepared and draped.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Radiographic Investigation of Coronal Plane and Patellar Height and Changes Following Tibial Deflection Osteotomy for Correction of Tibial Slope in Combination With ACL Reconstruction

Cance,

Dan,

Pineda

et al. 2024

Am J Sports Med

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Background: A tibial deflexion osteotomy (TDO) is performed to decrease the sagittal tibial slope to reduce the relative risk of anterior cruciate ligament (ACL) reconstruction (ACLR) graft failure. Given that coronal plane osteotomies can cause consequential changes in the sagittal plane to patellar height and tibial slope, potential changes to coronal plane alignment and patellar height can result after a sagittal plane osteotomy. Purpose: To compare preoperative and postoperative coronal plane alignment after TDO, as well as to analyze the effect of the osteotomy on patellar height. Study Design: Case series; Level of evidence, 4. Methods: This study was conducted on a consecutive series of patients with primary and revision ACLR with concomitant TDO between 2011 and 2022. Inclusion criteria were 1-stage autograft ACLR combined with supratubercular TDO with pre- and 3 months postoperative radiographs of sufficient quality. Indications for TDO were anterior instability requiring ACL revision surgery and a posterior tibial slope (PTS) >9° or a PTS >14° in the primary ACL surgery patients. Anteroposterior and lateral knee radiographs were reviewed, and the medial proximal tibial angle (MPTA), PTS, Caton-Deschamps index (CDI), and modified Insall-Salvati ratio were measured directly from the radiographs by 2 independent reviewers. Results: A total of 68 patients were included in this study. Pre- and postoperative radiographs were performed 1 month before and 3 months after surgery, respectively. There was a significant increase in the mean MPTA of 0.95° varus (SD, 2.1°; range, increase of 4.23° valgus to increase of 7.74° varus; P < .01), a decreased PTS of 8.86° (SD, 3.03°; P < .01), and an increased CDI of 0.08 (range, decrease of 0.27 to increase of 0.64) ( P < .01; SD, 0.17) in patients undergoing TDO. Insall-Salvati ratio measurements showed no difference. There was good intra- and interobserver reliability, with intraclass correlation coefficients of 0.97 and 0.91 for MPTA, 0.97 and 0.87 for PTS, 0.87 and 0.93 for CDI, and 0.88 and 0.76 the Insall-Salvati ratio. Conclusion: This study, the largest series on TDO for ACLR, demonstrates that the TDO can be performed safely without large changes to coronal alignment or patellar height. The tibial slope was reduced by a mean of 8.86° (range, 2.3°-11.5°; P < .01). The TDO produces a small statistically significant change to coronal alignment, inducing a mean increased varus of <1° and an increased patellar height of 0.1 CDI. Therefore, TDO can be performed safely without dramatic changes to coronal alignment or patellar height, this study highlights technical aspects to minimize iatrogenic varus.

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“…Dejour evaluated the results of his osteotomies to optimise the tibial translation during single leg stance and found that 2–3° of posterior tibial slope overcorrected the translation, whereas 4–6° of tibial slope optimised translation between 0 and 5 mm. This equates to a correction past the mean tibial slope by between 1 and 2 standard deviations [9]. Additionally, there is a move by some in the veterinary world to individualise the osteotomy based on the sagittal mechanical axis [5], as is planned and executed for coronal plane osteotomies in humans [25].…”

Section: Desired Slope Correctionmentioning

confidence: 99%

Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope

Dan,

Wills,

Crowley

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Anterior cruciate ligament (ACL) reconstruction (ACLR) is used to treat clinical instability post ACL rupture, however, there is a high rate of incomplete return to sport and rerupture. There is increasing interest in posterior tibial slope as an intrinsic risk factor for ACLR failure and persistent instability. Zoobiquity describes the collaboration between the human and veterinary professions in order to advance the scientific understanding of both fields. Given the cranial cruciate ligament (CCL) in dogs is synonymous with the anterior cruciate ligament in humans, functioning to control internal rotation and anterior translation, but osteotomies, rather than ligament reconstruction, are the mainstay of treatment for CCL rupture, this editorial sort to gain insights into this form of treatment from the veterinary world.Level of Evidence: Level V, evidence.

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Four to 6° Is the Target Posterior Tibial Slope After Tibial Deflection Osteotomy According to the Knee Static Anterior Tibial Translation

Cited by 15 publications

References 37 publications

Radiographic Investigation of Differences in Static Anterior Tibial Translation With Axial Load Between Isolated ACL Injury and Controls

Radiographic Investigation of Differences in Static Anterior Tibial Translation With Axial Load Between Isolated ACL Injury and Controls

Radiographic Investigation of Coronal Plane and Patellar Height and Changes Following Tibial Deflection Osteotomy for Correction of Tibial Slope in Combination With ACL Reconstruction

Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope

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