Medial and Lateral Posterior Tibial Slope in the Skeletally Immature: A Cadaveric Study

Anchustegui, Nicolas G.; Grimm, Nathan L.; Milbrandt, Todd A.; Rustad, Audrey; Shea, Cooper; Troyer, Stockton; Dingel, Aleksei; Ganley, Theodore J.; Fabricant, Peter D.; Shea, Kevin G.

doi:10.1177/23259671221088331

Cited by 4 publications

(2 citation statements)

References 48 publications

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“…Although this number deviates by roughly 1° to 1.5° from the adult normal PTSA, it is important to note that this study had a relatively small sample size with a high degree of variability based on the relatively large standard deviation. 2 Furthermore, we observed a mean PTSA in our control group of 7.3°± 4.3°, which was more consistent with the normal range we used. In another adult study, a PTSA ≥12° was associated with a 3.1 times greater risk of ACL reconstruction (ACLR) graft rupture compared with a slope <12°.…”

Section: Discussionsupporting

confidence: 88%

Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury

Vasudevan,

Rupp,

Zogby

et al. 2024

Am J Sports Med

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Background: Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries. Hypothesis/Purpose: The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury. Study Design: Cohort study; Level of evidence, 3. Methods: The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging–confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient. Results: Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age ( P = .90), sex ( P > .99), or body mass index ( P = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; P = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; P = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; P = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability. Conclusion: PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.

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Section: Discussionsupporting

confidence: 88%

Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury

Vasudevan,

Rupp,

Zogby

et al. 2024

Am J Sports Med

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“…Elyasi et al [ 42 ] showed that increased posterior tibial slope can induce an anterior translation of the tibia with respect to the femur, which raises a concern about whether it can increase the strain of the anterior cruciate ligament (ACL) and result in a higher risk of ACL rupture. Anchustegui et al [ 43 ] reported that an increased posterior tibial slope is an independent risk factor for ACL graft rupture, with a critical threshold of 12 degrees. Excessive tibial slope increases the posterior space, leading to a loose posterior cruciate ligament (PCL) in cruciate-retaining implants [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Knee Stiffness in Patients with Anteromedial Knee Osteoarthritis Undergoing Unicompartmental Knee Arthroplasty with Cemented Prostheses: A Short-Term, Retrospective, Case-Control Study

Wei,

Zhang,

Dong

et al. 2023

Med Sci Monit

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Background The present study was performed to determine the potential risk factors for postoperative knee stiffness in patients with anteromedial knee osteoarthritis undergoing unicompartmental knee arthroplasty with cemented prostheses. Material/Methods This retrospective cohort study evaluated patients with anteromedial knee osteoarthritis who underwent medial unicompartmental knee arthroplasty at our hospital between May 2017 and May 2020. The patients were divided into 2 groups according to their prognosis: those who experienced knee stiffness after undergoing unicompartmental knee arthroplasty and those who did not. The factors associated with stiffness after UKA were identified using univariate analysis. Frequencies are used to express categorical variables, while mean±SD is used to express continuous variables. The t test and chi-square test were used. A multivariate logistic regression model was built to identify the risk factors for postoperative stiffness. Results We included 590 knees in the study after unicompartmental knee arthroplasty. The overall incidence of postoperative stiffness in unicompartmental knee arthroplasty surgery was 10.17%. In terms of the radiological measurements, varus deformity (70.34% vs 29.66%) and tibial component posterior slope angle (4.8±2.0 vs 4.6±2.0, P <0.001) were significantly differences between the 2 groups. Four independent risk factors for stiffness after unicompartmental knee arthroplasty were identified: age (95% CI, 1.022–1.048), varus deformity (95% CI, 1.186–1.192), tibial component posterior slope angle (95% CI, 0.550–0.870), and preoperative maximum flexion (95% CI, 0.896–0.923). Conclusions The overall incidence of postoperative knee stiffness in patients with anteromedial knee osteoarthritis undergoing unicompartmental knee arthroplasty with cemented prostheses was 10.17%, which was at a moderate level compared to patients with other diseases undergoing unicompartmental knee arthroplasty. Four independent risk factors were identified: age, varus deformity, preoperative maximum flexion, and tibial component posterior slope angle. Awareness these risk factors might help surgeons prevent the occurrence of postoperative knee stiffness in patients with UKA.

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Is an excessively high posterior tibial slope a predisposition to knee injuries in children? Systematic review of the literature

Klein,

Rahab,

Rouanet

et al. 2024

Orthopaedics & Traumatology: Surgery & Research

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Medial and Lateral Posterior Tibial Slope in the Skeletally Immature: A Cadaveric Study

Cited by 4 publications

References 48 publications

Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury

Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury

Risk Factors for Postoperative Knee Stiffness in Patients with Anteromedial Knee Osteoarthritis Undergoing Unicompartmental Knee Arthroplasty with Cemented Prostheses: A Short-Term, Retrospective, Case-Control Study

Is an excessively high posterior tibial slope a predisposition to knee injuries in children? Systematic review of the literature

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