Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction

Jaecker, Vera; Drouven, Sabrina; Naendrup, Jan‐Hendrik; Kanakamedala, Ajay C.; Pfeiffer, Thomas; Shafizadeh, Sven

doi:10.1007/s00402-018-2968-z

Cited by 47 publications

(44 citation statements)

References 55 publications

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“…At the same time, current research is underlining that early ACLR improves the outcome after meniscal repair in conjunction with ACLR while protecting the knee from secondary injury like chondral lesions and aggravated meniscal lesions [1,2,34]. While osseous factors like tunnel positioning and tibial slope are established important factors for ACL graft failure, the role of periarticular structures, meniscal kinematics and strength deficits following ACLR is still a major focus of current research [6,[35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

Heitner²,

Mauch³

et al. 2020

Arch Orthop Trauma Surg

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Introduction Ruptures of the anterior cruciate ligament (ACL) can be accompanied by meniscal lesions. Generally, the rehabilitation protocols are altered by meniscal repair. Therefore, the aim of this study was to investigate the effect of meniscal repair on the early recovery of thigh muscle strength in ACL reconstruction (ACLR). Materials and methods We performed a matched cohort analysis of n = 122 isolated ACLR (CON) compared to n = 61 ACLR with meniscal repair (ACLR + MR). The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs (MM), 19 lateral meniscus repairs (LM) and 12 repairs of medial and lateral meniscus (BM). Isokinetic strength measurement was performed pre-operatively and 6 months post-surgery to perform a cross-sectional and a longitudinal analysis. All injuries were unilateral, and the outcome measures were compared to the non-affected contralateral leg. Results Six months postoperatively overall there is no significant difference between the groups (extension strength MR 82% vs. CON 85% and flexion strength 86% vs. 88%, resp.). Subgroup analysis showed that medial repairs exhibit a comparable leg symmetry while lateral repairs performed worse with leg symmetry being 76% in extension and 81% in flexion strength. Patients undergoing BM repair performed in between lateral and medial repairs (82% extension, 86% flexion). Conclusion Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. Interestingly, medial repairs seem to perform superior to lateral meniscal repair and repair of both menisci. Since the recovery of symmetric strength is a major factor in rehabilitation testing, these results will help to advise surgeons on appropriate rehabilitation protocols and setting realistic goals for the injured athlete. Level of evidence III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

Heitner²,

Mauch³

et al. 2020

Arch Orthop Trauma Surg

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“…2 Multiple studies have found an increased lateral tibial posterior slope (LTPS) on magnetic resonance imaging (MRI) to be a risk factor for primary ACL injury, 4,11,13,15,23,51 with confirmation of these findings in a large systematic review 58 and meta-analysis. 54 Recent studies have indicated that an increased tibial slope may also be a factor associated with revision risk after ACLR, 9,17,25,26,42,55 reporting a slope ≥12° to be associated with a higher risk of revision. 25,42,44,55 Some of these studies measured tibial slope with lateral radiographs, 25,42,55 which are limited in their ability to evaluate the complex 3-dimensional geometry of the tibial plateau.…”

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confidence: 99%

“…25,42,44,55 Some of these studies measured tibial slope with lateral radiographs, 25,42,55 which are limited in their ability to evaluate the complex 3-dimensional geometry of the tibial plateau. 12,15,56 In studies that measured LTPS with MRI, 9,17,26,43 results have been inconsistent, with an increase in LTPS ranging from 1° to 5° being associated with revision. One study found LTPS to play a role for female patients only, while another reported an association for ACLR performed through medial portal drilling only.…”

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confidence: 99%

“…One study found LTPS to play a role for female patients only, while another reported an association for ACLR performed through medial portal drilling only. 43 Some of this inconsistency in reporting across studies might be due to smaller sample sizes, with the largest including 57 cases of revision ACLR, 17 or to potential selection bias in identifying controls from a different source population than the cases. Given the variability in the literature, confirmation of these early reports on LTPS in a larger sample is needed.…”

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confidence: 99%

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The Association Between Tibial Slope and Revision Anterior Cruciate Ligament Reconstruction in Patients ≤21 Years Old: A Matched Case-Control Study Including 317 Revisions

et al. 2019

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Background: There is evidence that tibial slope may play a role in revision risk after anterior cruciate ligament reconstruction (ACLR); however, prior studies are inconsistent. Purpose: To determine (1) whether there is a difference in lateral tibial posterior slope (LTPS) or medial tibial posterior slope (MTPS) between patients undergoing revised ACLR and those not requiring revision and (2) whether the medial-to-lateral slope difference is different between these 2 groups. Study Design: Case-control study; Level of evidence, 3. Methods: We conducted a matched case-control study (2006-2015). Cases were patients aged ≤21 years who underwent revision surgery after primary unilateral ACLR; controls were patients aged ≤21 years without revision who were identified from the same source population. Controls were matched to cases by age, sex, body mass index, race, graft type, femoral fixation device, and post-ACLR follow-up time. Tibial slope measurements were made by a single blinded reviewer using magnetic resonance imaging. The Wilcoxon signed rank test and McNemar test were used for continuous and categorical variables, respectively. Results: No difference was observed between revised and nonrevised ACLR groups for LTPS (median: 6° vs 6°, P = .973) or MTPS (median: 4° vs 5°, P = .281). Furthermore, no difference was found for medial-to-lateral slope difference (median: −1 vs −1, P = .289). A greater proportion of patients with revised ACLR had an LTPS ≥12° (7.6% vs 3.8%) and ≥13° (4.7% vs 1.3%); however, this was not statistically significant after accounting for multiple testing. Conclusion: We failed to observe an association between revision ACLR surgery and LTPS, MTPS, or medial-to-lateral slope difference. However, there was a greater proportion of patients in the revision ACLR group with an LTPS ≥12°, suggesting that a minority of patients who have more extreme values of LTPS have a higher revision risk after primary ACLR. A future cohort study evaluating the angle that best differentiates patients at highest risk for revision is needed.

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“…Different studies revealed that open wedge HTO is associated with increase in posterior tibial slope [ 16 – 20 ]. As posterior tibial slope increases by 10 units, anterior tibial translation increases by 6 millimeters leading to more tension on the ACL [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature

Mortazavi

Noori

Vosoughi

et al. 2021

BMC Musculoskelet Disord

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Background Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. Case presentation A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. Conclusions Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. Level of evidence IV

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Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction

Cited by 47 publications

References 55 publications

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

The Association Between Tibial Slope and Revision Anterior Cruciate Ligament Reconstruction in Patients ≤21 Years Old: A Matched Case-Control Study Including 317 Revisions

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature

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