Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up

Gwinner, Clemens; Weiler, Andreas; Roider, Manoussos; Schaefer, F.; Jung, Tobias

doi:10.1177/0363546516666354

Cited by 98 publications

(86 citation statements)

References 48 publications

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“…may be at higher risk of PCL injury based upon their bony anatomy. 8,12,14 However, further research with larger sample size in both groups is needed to corroborate this clinical correlation.…”

Section: Discussionmentioning

confidence: 90%

“…2,11,16,19 Further, a recent study has identified a decreased posterior tibial slope as a factor in increased posterior tibial translation in single-bundle PCL reconstructions on follow-up kneeling PCL stress radiographs. 12 Additionally, authors noted that these results were irrespective of patient gender and number of ligaments addressed during PCL reconstruction. 12 12 No study to date has examined the loading experienced in a single bundle or double bundle PCL graft when subjected to loading conditions at varying slopes and flexion angles which could reveal an ideal slope or range of slopes that may be protective of a reconstructed PCL.…”

Section: Discussionmentioning

confidence: 96%

“…Patients with a normal tibial slope or increased tibial slope may require larger force at the time of injury in order to overcome the protective effect of posterior tibial slope on PCL injuries. 10,12 Previous laboratory research has shown that increasing posterior tibial slope via tibial osteotomy in PCL-deficient knees reduces tibial sag by shifting the resting position of the tibia anteriorly. 10,11 Similarly, Singerman et al 24 conducted a biomechanical study and reported a significant increase in PCL strain with decreasing tibial slope from 10˚ to 5˚ following total knee arthroplasty with an opening wedge tibial osteotomy (P < .0001).…”

Section: Discussionmentioning

confidence: 99%

“…Recent biomechanical and clinical investigations have identified sagittal plane posterior tibial slope as a potential risk factor for anterior cruciate ligament injury because of its substantial effects on the kinematics of the native and surgically treated knee. [10][11][12][13]26 The average native tibial slope has previously been described as 7-10 posteriorly and is suggested to have a significant impact on in situ forces experienced by the cruciate ligaments. 11,18,21 Increased posterior tibial slope has been reported to alter the kinematics of the knee joint by anteriorly shifting the resting position of the tibia and subsequently increasingly the in situ forces on the anterior cruciate ligament (ACL).…”

Section: Introductionmentioning

confidence: 99%

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Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

et al. 2019

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Background: Recent biomechanical studies have identified sagittal plane posterior tibial slope as a potential risk factor for posterior cruciate ligament (PCL) injury because of its effects on the kinematics of the native and surgically treated knee. However, the literature lacks clinical correlation between primary PCL injuries and decreased posterior tibial slope. Purpose/Hypothesis: The purpose of this study was to retrospectively compare the amount of posterior tibial slope between PCL injured patients and an age/gender matched PCL intact controls. It was hypothesized that patients with PCL injuries would have a significantly decreased amount of posterior tibial slope compared to patients without PCL injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent a primary PCL reconstruction without ACL injury between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed using the lateral radiographs of both PCL injured patients and matched controls without clinical or MRI evidence of ligamentous injury. Mean values of posterior tibial slope were compared between the two groups. Interrater and intrarater agreement was assessed for the tibial slope measurement technique using a two-way randomeffects model to calculate the intraclass correlation coefficient (ICC). Results: One hundred four patients with PCL tears met the inclusion criteria and 104 control patients were matched to the PCL injured group according to age and gender. There were no significant differences in patient age (P=.166), gender (P=.345), or BMI (P=.424) between the PCL injured and control groups. Of the PCL tear cohort, 91 patients (87.5%) sustained a contact mechanism of injury, while 13 patients (12.5%) reported a noncontact mechanism of injury. The mean posterior tibial slope was 5.7  2.1 degrees (95% confidence interval [CI]: 5.3˚, 6.1˚) and 8.6  2.2 degrees (95% CI: 8.1˚, 9.0˚) for the PCL injured and matched control groups, respectively (P<.0001). Subgroup analysis of the PCL injured patients according to mechanism of injury demonstrated significant differences in posterior tibial slope between noncontact (4.6  1.8˚) and contact (6.2  2.2˚) injuries for all PCL tear patients (P=.013) and among patients with isolated PCL tears (P=.003). The tibial slope measurement technique was highly reliable, with an ICC of 0.852 for interrater and an ICC of 0.872 for intrarater reliability. Conclusion: A decreased posterior tibial slope was associated with PCL tear patients compared to age and gender-matched control patients with intact PCLs. Decreased tibial slope appears to be a risk factor for primary PCL injury. However, further clinical research is needed to assess if decreased posterior tibial slope affects posterior knee stability and outcomes following PCL reconstructions.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

et al. 2019

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“…Similarly, under conditions where the tibia bears axial load and backward external force, the reduction of the tibial slope leads to an increase of the stress in the PCL which leads to rupture. Therefore, the increase of the tibial slope has a protective effect on the PCL, and the researchers found that a 1-degree increase in the posterior tibial slope decreased PCL force by 6 N [26][27][28][29]. Bernhardson et al con rmed the above opinions and they found that a decreased posterior tibial slope was associated with patients who have PCL tears [14].…”

Section: Discussionmentioning

confidence: 99%

What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

Fan

Zheng

Zang

et al. 2020

Preprint

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Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture and determine risk factors in men and women separately. Methods A retrospective case-control study of 48 patients (comprised 25 men and 23 women) with PCL avulsion fracture compared with 48 age- and sex-matched controls was performed from 2012 to 2018. MRI measurements of the knee were acquired in the sagittal, coronal, and axial sequences. The assessed measurements including intercondylar notch width index, medial/lateral posterior tibial slopes, and coronal tibial slope were compared between case and control groups in both women and men. Univariable and binary logistic regression analyses were used to identify independent risk factors that were associated with PCL avulsion fracture. Results When female patients were analyzed, the notch width index (coronal) was significantly smaller, and the lateral posterior tibial slope was significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.307, OR = 0.735, p = 0.025) was found to be an independent factor. When male patients were analyzed, no radiographic parameter was found to have a statistical difference between the case and control groups. Conclusions Notch width index (coronal) and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.

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Increased medial tibial slope is a possible risk factor for patellar cartilage lesions

Hoffeld,

Hockmann,

Wahlers

et al. 2024

J. exp. orthop.

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IntroductionAxial malalignment in the coronal plane has been identified as a significant risk factor for knee cartilage damage, leading to osteoarthritis progression. However, the impact of sagittal axial deviation on cartilage damage remains underexplored. Biomechanical studies have suggested that an increased tibial slope leads to altered pressure distribution in the articular cartilage, potentially contributing to cartilage damage. Despite these biomechanical insights, clinical evidence linking increased tibial slope to cartilage damage is lacking.MethodsThis retrospective study focuses on patients who underwent surgical cartilage transplantation between January 2016 and July 2023. A total of 108 patients were divided into two groups based on the presence or absence of other pathologies contributing to cartilage damage. Clinical data, including tibial slope measurements from lateral radiographs, were collected. A further subgroup‐matched pair analysis was conducted comparing cases with patellar lesions and healthy knees. Statistical analysis compared tibial slope values between groups and assessed correlations between tibial slope and cartilage lesion grade.ResultsPatients without other identifiable pathologies exhibited a significantly higher medial tibial slope compared to those with known causative factors for cartilage damage (p < 0.05). Cartilage damage, particularly in the patellar region, was more prevalent in patients with an increased tibial slope. Patients with patellar lesions had a significant increased slope than healthy controls (p < 0.05). However, there was no significant correlation between cartilage lesion grade and tibial slope.ConclusionThe study identified increased medial tibial slope as a possible independent risk factor for cartilage damage in the knee, especially in the patellar region.Level of EvidenceLevel IV.

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Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up

Cited by 98 publications

References 48 publications

Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

Increased medial tibial slope is a possible risk factor for patellar cartilage lesions

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