Assessment of the tibial slope is highly dependent on the type and accuracy of the preceding acquisition

Gwinner, Clemens; Fuchs, Michael; Sentuerk, Ufuk; Perka, Carsten; Walter, Thula; Schatka, Imke; Rogasch, J

doi:10.1007/s00402-019-03201-y

Cited by 21 publications

(39 citation statements)

References 30 publications

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“… 9 Even though the TS appears to be smaller if assessed on MRI, radiographs have been determined to provide an accurate and objective quantification of the TS as well as a high correlation with MRI. 13 , 16 In addition, the clinical use of radiography might be greater than the use of MRI assessment, which is more time-consuming and requires specialized software. 13 Finally, this study does not indicate whether reducing the TS can change the odds of a subsequent graft failure.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 16 In addition, the clinical use of radiography might be greater than the use of MRI assessment, which is more time-consuming and requires specialized software. 13 Finally, this study does not indicate whether reducing the TS can change the odds of a subsequent graft failure.…”

Section: Discussionmentioning

confidence: 99%

“…Although the best available radiographs were chosen, not all images included enough tibial shaft to determine the width of the shaft at a distance of 15 cm distal to the joint line. In these instances, the most distal width (if ≥12 cm) 13 was measured based on the aforementioned conditions ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

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Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

et al. 2021

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Background: Increased tibial slope (TS) is believed to be a risk factor for anterior cruciate ligament (ACL) tears. Increased TS may also promote graft insufficiency after ACL reconstruction. Purpose: To delineate the relationship between TS and single as well as multiple graft insufficiencies after ACL reconstruction. Study Design: Cohort study; Level of evidence 3. Methods: We retrospectively identified 519 patients who had sustained ACL graft insufficiency after primary or revision ACL reconstruction (1 graft insufficiency, group A; 2 graft insufficiencies, group B; and ≥3 graft insufficiencies, group C). In addition, a subgroup analysis was conducted in 63 patients who received all surgical interventions by 2 specialized high-volume, single-center ACL surgeons. TS was measured by an observer with >10 years of training using lateral knee radiographs, and intrarater reliability was performed. Multiple logistic and univariate Cox regression was used to assess the contribution of covariates (TS, age, sex, and bilateral ACL injury) on repeated graft insufficiency and graft survival. Results: The study included 347 patients, 119 female and 228 male, who were 24 ± 9 years of age at their first surgery (group A, n = 260; group B, n = 62; group C, n = 25). Mean TS was 9.8°± 2.7° (range, 3°-18°). TS produced the highest adjusted odds ratio (1.73) of all covariates for repeated graft insufficiency. A significant correlation was found between TS and the number of graft insufficiencies ( r = 0.48; P < .0001). TS was significantly lower in group A (9.0°± 2.3°) compared with group B (12.1°± 2.5°; P < .0001) and group C (12.0°± 2.6°; P < .0001). A significant correlation was seen between the TS and age at index ACL tear ( r = −0.12; P = .02) as well as time to graft insufficiency ( r = −0.12; P = .02). A TS ≥12° had an odds ratio of 11.6 for repeated ACL graft insufficiency. Conclusion: The current results indicate that patients with a markedly increased TS were at risk of early and repeated graft insufficiency after ACL reconstruction. Because the TS is rarely accounted for in primary and revision ACLR, isolated soft tissue procedures only incompletely address recurrent graft insufficiency in this subset of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

et al. 2021

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“…MRI studies 17,19 only utilized the proximal tibia. Short and full-length radiographs do not provide the same results of tibial slope measurements with higher tibial slope in short radiographs 17 and more accuracy on long-leg X-ray radiographs.…”

Section: Discussionmentioning

confidence: 99%

A Cadaveric Anatomical Study of the Relationship between Proximal Tibial Slope and Coronal Plane Deformity

et al. 2021

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Medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) are commonly used to characterize the geometry of proximal tibia and are important considerations in lower extremity realignment procedures and total knee arthroplasty. This study utilized a large cadaveric collection to explore relationships between tibial slope and coronal plane deformity of the tibia. We utilized 462 well-preserved skeletons (924 tibiae), excluding any with fracture or obvious rheumatologic or infectious findings. Custom cards were made with different sized arcs on the bottom surface, so that they could rest on the anterior and posterior aspects of the medial and lateral tibial plateaus of each bone to measure PPTA. Previously measured MPTA values for the same bones were also utilized. Multiple regression analysis was used to determine relationship between MPTA and medial and lateral PPTAs. The mean age was 56 ± 10 years, with 13% female and 31% African American (remainder Caucasian). The mean MPTA was 87.2 ± 2.4 degrees. The mean medial plateau PPTA was 81.5 ± 3.8 degrees and mean lateral plateau PPTA was 81.3 ± 3.7 degrees. Regression analysis found that MPTA was significantly associated with both medial and lateral PPTAs (standardized betas 0.197 and 0.146, respectively, p < 0.0005 for both). There was a significant correlation between lateral and medial PPTAs (r = 0.435, p = 0.03). The clinical significance of these findings warrants further investigation and emphasizes the importance of carefully assessing the sagittal plane when planning reconstruction of a tibia with varus or valgus deformity, particularly high tibial osteotomies.

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“…In order to achieve this, a physiological reference is required for the preoperative planning [ 23 , 24 , 25 ]. The current literature indicates a highly variable intra-individual TS [ 7 , 22 , 26 ]. However, the reference values are based on different imaging procedures and measurement methods [ 5 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Morphological Analysis of the Tibial Slope in 720 Adult Knee Joints

et al. 2022

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Background: The tibial slope (TS) defines the posterior inclination of the tibial plateau (TP). The “individual physiological” TS plays a crucial role in knee-joint stability and should be taken into account in knee-joint surgery. The aim of this study was to analyse the specific morphology of the TS for the medial (med) and lateral (lat) TP in relation to patient characteristics and the measurement method. Methods: In this retrospective study, MRI images of knee joints from 720 patients (mean age: 49.9 years [±17.14]) were analysed. The TS was assessed using two established methods according to Hudek (TSH) and Karimi (TSK) for the med and lat TP and gender/side specificity was analysed. Results: TSH for the med and lat TP showed significantly (p < 0.001) different values compared to TSK (TSKmed: 2.6° (±3.7), TSHmed: 4.8° (±3.5); TSKlat: 3.0° (±4.0), TSHlat: 5.2° (±3.9)). The angles of the lat TP were significantly higher than those of the med TP (TSK: p < 0.001; TSH: p = 0.002). Females showed a higher med and lat TS compared to males (p < 0.001). Conclusions: The measurement method has an influence on the values of the TS in knee-joint MRIs. The TS is significantly different for the med and lat TP regardless of the measurement method. There are gender-specific differences for the TS.

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Assessment of the tibial slope is highly dependent on the type and accuracy of the preceding acquisition

Cited by 21 publications

References 30 publications

Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

A Cadaveric Anatomical Study of the Relationship between Proximal Tibial Slope and Coronal Plane Deformity

Morphological Analysis of the Tibial Slope in 720 Adult Knee Joints

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