Greater Static Anterior Tibial Subluxation of the Lateral Compartment After an Acute Anterior Cruciate Ligament Injury Is Associated With an Increased Posterior Tibial Slope

Song, Gonghua; Zhang, Hui; Zhang, Jin; Liu, Xin; Xue, Zhe; Qian, Yi; Feng, Hao

doi:10.1177/0363546518760580

Cited by 49 publications

(53 citation statements)

References 23 publications

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“…The most evident result is that the PTS was larger in the study group than that in the control group. This was similar to the recent epidemiological study performed by Song et al, 25 in which increased PTS was identified as an independent anatomic risk factor of excessive (>10 mm) ATS in extension after ACL injury. In that study, the mean PTS of the patients with excessive (>10 mm) ATS in extension was 16.6°, suggesting that a larger PTS may lead to an anteriorly subluxated tibial position after ACL injury.…”

Section: Discussionsupporting

confidence: 92%

“…24,27 Increases in ATS in extension have been observed in the setting of combined posterior horn of medial and lateral meniscal tears. 7,18 Furthermore, increased posterior tibial slope (PTS) has been shown to portend greater ATS in extension in ACL-deficient knees; Song et al 25 found that patients who had excessive (>10 mm) ATS in extension (resting pivot-shift position) after ACL injury all had PTS >15°. Alterations of the PTS may result in an anterior shift of the resting position of the tibia relative to the femur.…”

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confidence: 99%

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Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

Song

Zhang

et al. 2020

Am J Sports Med

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Background: Anterior tibial subluxation (ATS) in extension after anterior cruciate ligament (ACL) injury highlights an increased anterior position of the tibia relative to the femur. Recent studies demonstrated that subluxation is sometimes irreducible and the normal tibiofemoral relationship is not restored by ACL reconstruction (ACLR), which raises concerns regarding clinical outcomes after ACLR. Hypothesis: Excessive preoperative ATS in extension is associated with inferior knee stability after anatomic ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2016 to January 2017, a total of 487 consecutive patients with clinically diagnosed noncontact ACL injuries who underwent primary anatomic ACLR were retrospectively analyzed. Of these patients, 430 met the criteria for inclusion in this study. Anterior subluxation of the lateral and medial compartments (ASLC and ASMC) in extension relative to the femoral condyles was measured on preoperative magnetic resonance imaging. Twenty patients (study group) who demonstrated excessive (>10 mm) ASLC and ASMC in extension were matched 1:2 to 40 participants (control group) who showed minimal or no (<3 mm) ASLC and ASMC in extension. The amount of ASLC and ASMC in extension relative to the femoral condyles at 2 years postoperatively was the primary outcome. Moreover, the Lysholm score, IKDC grade (International Knee Documentation Committee), and stability assessments (pivot-shift test and KT-1000 arthrometer side-to-side difference) were evaluated preoperatively and at the last follow-up visit. Results: The preoperative mean ASLC and ASMC in extension of the study group were both significantly larger than those of the control group (study group vs control group: ASLC, 13.5 mm vs 1.2 mm; ASMC, 12.4 mm vs 1.0 mm; P < .05). Moreover, patients in the study group showed significantly larger posterior tibial slope than the patients in the control group (17.8°± 2.5° vs 9.5°± 1.5°; P < .05). At the final follow-up visit, the mean ASLC and ASMC of the study group were 8.1 mm and 7.3 mm, which were significantly larger than those of the control group (ASLC, 0.9 mm; ASMC, 0.7 mm; P < .05). In addition, the study group showed inferior knee stability when compared with the control group in terms of both the pivot-shift test (study group vs control group: 2 grade 2, 10 grade 1, and 8 grade 0 vs 1 grade 1 and 39 grade 0; P < .05) and the KT-1000 arthrometer side-to-side difference (study group vs control group: 4.4 ± 1.2 mm vs 1.5 ± 0.6 mm; P < .05). Furthermore, the study group showed significantly lower mean Lysholm score (study group vs control group: 80.3 ± 6.3 vs 93.3 ± 4.3, P < .05) and IKDC grading results (study group vs control group: 3 grade C, 16 grade B, and 1 grade A vs 3 grade B and 37 grade A; P < .05) as compared with the control group. Conclusion: In this short-term study, the excessive (>10 mm) preoperative ATS in extension after ACL injury was associated with inferior knee stability after anatomic ACLR.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

Song

Zhang

et al. 2020

Am J Sports Med

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“…First, the value of ATSLC obtained in the supine position may not represent what truly occurs in the weightbearing situation. However, nearly all previous studies investigating the ATSLC in extension performed the measurements on nonweightbearing MRI or fluoroscopy, 2-4,17,26,28,29,36,37 which makes our results comparable with previous literature. Second, a meniscal lesion with a length ≤10 mm between its location and LMPR tibial attachment as measured by the intra-articular probe was determined to be a radial tear by a single researcher, which probably brought subjectivity to the classification of LMPR lesions.…”

Section: Discussionsupporting

confidence: 84%

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

et al. 2020

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Background: The lateral meniscus posterior root (LMPR) lesion further decreases dynamic knee stability after anterior cruciate ligament (ACL) injury owing to the loss of the “wedge effect” maintained by the posterior horn of the lateral meniscus. However, the effect of LMPR lesions on the static tibiofemoral relationship in extension after ACL injuries is not determined. Purpose: To (1) determine the effect of LMPR lesions on anterior tibial subluxation of the lateral compartment (ATSLC) in extension in patients with ACL injuries and to (2) identify the LMPR-related factors associated with excessive ATSLC in extension. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2017, 405 consecutive patients with diagnosed ACL injuries who underwent primary ACL reconstructions were retrospectively reviewed. Among them, 45 patients with combined ACL injuries and LMPR lesions (ACL+LMPR group) and 51 patients with isolated ACL injuries (ACL group) were identified. Values of ATSLC in extension were measured on preoperative supine magnetic resonance imaging and classified into high grade (≥6 mm) and low grade (<6 mm). The mean ATSLC in extension and the proportion of patients with high-grade ATSLC in extension were compared between the groups by univariate analysis. In the ACL+LMPR group, predictors of high-grade ATSLC in extension—including age, sex, body mass index, affected side, cause of injury, period from injury (<12 or ≥12 weeks), LMPR lesion pattern (radial tear or root avulsion), and meniscofemoral ligament integrity (intact or impaired)—were assessed by univariate analysis and multivariate logistic regression analysis. Results: The mean ATSLC in extension in the ACL+LMPR group was significantly greater than that in the ACL group (5.6 mm vs 3.1 mm; P = .001). The proportion of patients with high-grade ATSLC in extension in the ACL+LMPR group was also significantly larger than that in the ACL group (44.4% vs 15.7%; P = .002). In addition, the root avulsion (instead of radial tear) (odds ratio, 28.750; 95% CI, 2.344-352.549; P = .009) and the period from injury ≥12 weeks (odds ratio, 17.095; 95% CI, 1.207-242.101; P = .036) were determined to be the 2 independent predictors of high-grade ATSLC in extension. However, age, sex, body mass index, affected side, cause of injury, and meniscofemoral ligament integrity were not. Conclusion: After ACL injuries, concomitant LMPR lesion further increased ATSLC in extension. Chronic LMPR avulsion was associated with high-grade ATSLC in extension.

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“…Steep PTS was recently identified as an independent anatomic risk factor of excessive static ATS in extension (>10 mm) after ACL injury. 28 In that study, the mean PTS of the patients with excessive ATS in extension (>10 mm) was 16.6°. Grassi et al 13 suggested that the steep PTS combined with excessive ATS in extension (>10 mm) after ACL injury represented the “worst-case scenario” for ACLR.…”

Section: Discussionmentioning

confidence: 76%

Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears

Song

Zheng

et al. 2020

Am J Sports Med

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Background: Steep posterior tibial slope (PTS; >13°), excessive anterior tibial subluxation (ATS) in extension (>10 mm), and meniscus posterior horn tears (MPHTs) have been identified to be associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Recent studies have reported that steep PTS is directly correlated with excessive ATS in extension and concomitant MPHTs, especially for those patients with chronic (>6 months) ACL deficiency. There is increasing biomechanical evidence that slope-reducing tibial osteotomy decreases ATS in extension and protects the ACL graft. Hypothesis: Slope-reducing tibial osteotomy combined with primary ACLR is effective for producing improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months). Study Design: Case series; Level of evidence, 4. Methods: Between June 2016 and January 2018, 18 patients with ACL injuries who had steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months) underwent slope-reducing tibial osteotomy combined with primary ACLR. The PTS and anterior subluxation of the lateral and medial compartment (ASLC and ASMC) in extension before and after the index procedures were regarded as primary clinical outcomes. Moreover, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) objective grade, pivot-shift test, and KT-1000 side-to-side difference were evaluated preoperatively and at the minimum 2-year follow-up visit. Results: The mean PTS was 18.5° (range, 17°-20°) preoperatively and 8.1° (range, 7°-9°) postoperatively ( P < .01). The mean ASLC and ASMC in extension were 12.1 mm and 11.9 mm preoperatively, which reduced to 1.0 mm and 1.5 mm at the last follow-up visit ( P < .05). In addition, all of the following showed significant improvements (pre- vs postoperatively): mean Lysholm score (46.5 vs 89.5; P < .05), mean Tegner activity score (5.7 vs 7.3; P < .05), IKDC objective grading results (18 grade D vs 14 grade A and 4 grade B; P < .05), pivot-shift tests (15 grade 2+ and 3 grade 3+ vs 18 grade 0; P < .01), and KT-1000 side-to-side difference (13.0 mm vs 1.6 mm; P < .01). Moreover, no graft reruptures were found at the final follow-up visit. Conclusion: In this study, slope-reducing tibial osteotomy combined with primary ACLR effectively improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).

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Greater Static Anterior Tibial Subluxation of the Lateral Compartment After an Acute Anterior Cruciate Ligament Injury Is Associated With an Increased Posterior Tibial Slope

Cited by 49 publications

References 23 publications

Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears

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