Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review

Abstract

PurposeTo determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction.MethodsThree databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R‐AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p‐values for comparisons of values between patients with PCL pathology and control patients, were recorded.ResultsNine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0–7.0) and 6.5 (range: 5.0–9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90–3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0–2.2) and 2.6 (range: 2.4–2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries.ConclusionDecreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries.Level of EvidenceLevel III.

Magnetic Resonance Imaging-Based Morphometric Analyses of the Bicruciate Injury of the Knee: Is There a Clue in the Distal Femur?

“…There have been isolated reports of PCL injuries due to decreased notch width. Apart from femoral notch indices, these studies have elucidated that the tibial slope also contributes to PCL injury severity [9,15,16]. Huang et al noted a notch width of 20.1 mm ± 0.2 mm in their cohort [9].…”

The tibial capsular reflection and septum in posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction

“…Although the posterior cruciate ligament reconstruction (PCLR) technique has evolved considerably over recent decades [1,14,15], there is still no consensus regarding the optimal surgical approach for PCLR [6,11], including whether to perform single-bundle or doublebundle reconstruction [20], whether to perform transtibial or tibial inlays and the positioning of the tunnel. Currently, there are many possible reasons for the failure of PCLR surgery [21], one of which is incorrect bone tunnel placement [24], particularly positioning of the tibial bone tunnel, which is considered to be very important in PCLR [8,18].…”