Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice

Cruz, Christian A.; Mannino, Brian J.; Pike, Andrew N.; Thoma, David C; Lindell, Kenneth K.; Kerbel, Yehuda E.; McCadden, Austin; Lopez, Andrew; Bottoni, Craig R.

doi:10.1016/j.jisako.2022.04.002

Cited by 8 publications

(10 citation statements)

References 23 publications

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“…They found a significant association between the high-grade instability group with anterolateral ligament injuries and an LPTS >9°, suggesting that bony morphology in the lateral compartment may have an important relationship with rotational instability. While the previous literature has consistently found an increased PTS measured on radiography to be associated with ACL injuries, 7,9,16,26,27,32 studies that have utilized MRI to measure the PTS demonstrate less agreement. Several studies utilizing MRI have not found an association of an elevated PTS with primary ACL injuries or graft failure, 6,17,21 while others have found either the medial 37 or the lateral 5,8,31 tibial plateau to be significantly steeper in those with ACL injuries.…”

Section: Discussionmentioning

confidence: 91%

“…The slope of the tibial plateau, or posterior tibial slope (PTS), has been identified as a biomechanical risk factor for ACL injuries and has received increased scrutiny in the past decade particularly because of the underlying mechanism of increased anteromedial bundle strain during ground impact in knees with a greater PTS. 7,16,27 Multiple studies in the ACL literature have found an increased PTS to be an independent risk factor for ACL injuries, 16,27 graft failure after primary ACLR, 7,9,26,30,32 concomitant meniscal injuries, 3,11,24 and even complications such as graft roof impingement. 34…”

mentioning

confidence: 99%

“…the past decade particularly because of the underlying mechanism of increased anteromedial bundle strain during ground impact in knees with a greater PTS. 7,16,27 Multiple studies in the ACL literature have found an increased PTS to be an independent risk factor for ACL injuries, 16,27 graft failure after primary ACLR, 7,9,26,30,32 concomitant meniscal injuries, 3,11,24 and even complications such as graft roof impingement. 34 Although numerous studies have focused on the relationship between the PTS and graft failure after ACLR, fewer have examined the association between the PTS and the risk for subsequent contralateral ACL injuries.…”

mentioning

confidence: 99%

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Posterior Tibial Slope in Patients Undergoing Bilateral Versus Unilateral ACL Reconstruction: MRI and Radiographic Analyses

Garra,

Li,

Triana

et al. 2023

Am J Sports Med

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Background: An increased posterior tibial slope (PTS) is a risk factor for primary anterior cruciate ligament (ACL) tears and graft failure, but the PTS has not been well-defined in those who have experienced bilateral ACL injuries. Purpose: The primary aim was to compare the PTS, as well as the rate of an elevated PTS (>12° on lateral radiography; >7° on magnetic resonance imaging [MRI]), between patients who have undergone bilateral ACL reconstruction (ACLR) versus unilateral ACLR. A secondary purpose was to examine whether these associations remained consistent on both plain radiography and MRI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively identified patients who underwent primary ACLR at our institution from the years 2012 to 2020. Patients who underwent nonsimultaneous bilateral ACLR (n = 53) were matched to those who underwent unilateral ACLR (n = 53) by age, sex, and body mass index. Exclusion criteria were rotated lateral radiographs, MRI scans of inadequate quality, and concomitant ligament injuries or fractures. Those who had undergone unilateral ACLR with <5-year follow-up were further excluded. There were 3 blinded readers who measured the PTS on lateral radiographs, while the medial PTS (MPTS) and lateral PTS (LPTS) were measured on MRI scans. Bivariate regression was performed to determine the correlation between radiographic and MRI measurements. Results: The PTS on radiography (11.26° vs 10.13°, respectively; P = .044) and the LPTS on MRI (7.32° vs 6.08°, respectively; P = .012) in the bilateral ACLR group were significantly greater than those in the unilateral ACLR group but not the MPTS on MRI (4.55° vs 4.17°, respectively; P = .590). The percentage of patients in the bilateral group with a radiographic PTS >12° was 41.0% compared with 13.2% in the unilateral group ( P = .012). The bilateral group had a significantly higher rate of an LPTS >7° compared with the unilateral group (53.8% vs 32.1%, respectively; P = .016) but not for an MPTS >7° ( P = .190). On MRI, the LPTS (6.90°± 2.73°) was significantly greater than the MPTS (4.41°± 2.92°) ( P < .001). There was a weak correlation between MPTS and radiographic PTS measurements ( R = 0.24; P = .021), but LPTS and radiographic PTS measurements were not significantly correlated ( R = 0.03; P = .810). Conclusion: Patients who underwent bilateral ACLR had a significantly greater PTS on radiography and a significantly greater LPTS on MRI compared with those who underwent unilateral ACLR. The rate of a radiographic PTS >12° was 2.4 times greater among patients undergoing bilateral ACLR compared with those undergoing unilateral ACLR. PTS measurements on radiography demonstrated a weak to negligible correlation with PTS measurements on MRI, suggesting that future normative PTS values should be reported specific to the imaging modality.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Posterior Tibial Slope in Patients Undergoing Bilateral Versus Unilateral ACL Reconstruction: MRI and Radiographic Analyses

Garra,

Li,

Triana

et al. 2023

Am J Sports Med

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“…These criteria arestated also by many previous studies [10,11,14,17,18] . HTO for the treatment of medial knee osteoarthritis is an established method, having been described by many authors as being effective in case of unicompartmental destruction in young patients in whom no or only very minor lateral degeneration is present [2][3][4][5] .…”

Section: Discussionmentioning

confidence: 99%

“…HTO realigns the mechanical axis of the lower limb and unloads the affected compartment, thereby transferring weightbearing forces to the healthy knee compartment [2] . Furthermore, biomechanical studies have shown that planned alteration of the posterior tibial slope can also help improve or restore stability in the sagittal plane in ligament deficient knees [3] . Thus, valgus-producing HTOs, either lateral closing wedge (LCW) or medial opening wedge (MOW), should be considered as a preferred alternative to a knee arthroplasty, particularly in young, active patients with degenerative changes and concomitant cruciate injuries [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction and Medial Opening Wedge High Tibial Osteotomy Using Locked Plate and Synthetic Bone Graft (TUTOBONE®)

ELNOKEETY¹,

REDA

2022

The Medical Journal of Cairo University

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Background: High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment.Aim of Study: Was to prospectively assess the effectiveness of management of varus angulated-ACL deficient knees by simultaneous arthroscopic ACL reconstruction and medial opening wedge high tibial osteotomy (HTO) using locked plate and synthetic bone graft (TUTOBONE®). The IKDC scoring system is used to assess the patients. Clinical outcomes are assessed preoperatively and at 20 months post-operatively.

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Bone‐patellar tendon‐bone autograft is associated with a higher rate of return to preinjury levels of performance in high‐level athletes than anterior cruciate ligament reconstruction using hamstring autograft

Tomihara,

Hashimoto,

Okazaki

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeReturn to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL‐R) for athletes when ACL graft rupture is a career‐threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL‐R using bone‐patellar tendon‐bone (BPTB) or hamstring (HT) autograft in high‐level athletes with a minimum postoperative follow‐up of 24 months.MethodsThis retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL‐R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow‐ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow‐ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury.ResultsNinety‐nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL‐R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty‐three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300–5.160; p = 0.007) was associated with a higher potential for RTP after ACL‐R. The incidence of ACL graft rupture after ACL‐R decreased with BPTB (OR, 0.861; 95% CI, 0.770–0.962; p = 0.009).ConclusionsThe use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL‐R using HT autograft.Level of EvidenceLevel IV, retrospective case series.

show abstract

Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice

Cited by 8 publications

References 23 publications

Posterior Tibial Slope in Patients Undergoing Bilateral Versus Unilateral ACL Reconstruction: MRI and Radiographic Analyses

Posterior Tibial Slope in Patients Undergoing Bilateral Versus Unilateral ACL Reconstruction: MRI and Radiographic Analyses

Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction and Medial Opening Wedge High Tibial Osteotomy Using Locked Plate and Synthetic Bone Graft (TUTOBONE®)

Bone‐patellar tendon‐bone autograft is associated with a higher rate of return to preinjury levels of performance in high‐level athletes than anterior cruciate ligament reconstruction using hamstring autograft

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