Elevated Posterior Tibial Slope Is Associated With Anterior Cruciate Ligament Reconstruction Failures: A Systematic Review and Meta-analysis

Duerr, Robert A.; Ormseth, Benjamin; Adelstein, Jeremy M.; Garrone, Andrew; DiBartola, Alex C.; Kaeding, Christopher C.; Flanigan, David C.; Siston, Robert A.; Magnussen, Robert A.

doi:10.1016/j.arthro.2022.12.034

Cited by 12 publications

(7 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Existing literature show an association between increased posterior tibial slope and ACL injury [4, 9, 11, 20]. This can be explained through an increased posterior tibial slope causing anterior displacement of the tibia altering the biomechanics of the ACL, placing the ligament at an increased risk of injury [20].…”

Section: Discussionmentioning

confidence: 99%

Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review

Vivekanantha

Diao

Cohen

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeTo determine what knee morphological factors are associated with the development of mucoid degeneration of the anterior cruciate ligament (ACL). Methods Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining knee morphological factors that potentially lead to the development of mucoid degeneration of the ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on receiver operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and speciicity, odds ratios, as well as p values for comparisons of values between mucoid degeneration of the ACL and control patients were recorded. The Methodological Index for Non-Randomized Studies (MINORS) score was used for all studies to perform a quality assessment of included studies. Results A total of 7 studies comprising 1326 patients (1330 knees) were included in this review. Four studies reported a signiicant association between increasing posterior tibial slope angles and mucoid degeneration of the ACL presence, with one study specifying that posterolateral tibial slope had a greater association than posteromedial tibial slope. Two studies reported a signiicant association between lower notch width index values and mucoid degeneration of the ACL presence. One study found that the presence of trochlear dysplasia was correlated with mucoid degeneration of the ACL and two studies found that increased tibial tuberosity-trochlear groove distance (TT-TG) was associated with mucoid degeneration of the ACL. Conclusion Increased posterior tibial slope, decreased notch width index, and elevated TT-TG and trochlear dysplasia were associated with the presence of mucoid degeneration of the ACL. Information from this review can aid surgeons in understanding what morphological features predispose their patients to the development of mucoid degeneration of the ACL. Identifying what features predispose patients to mucoid degeneration of the ACL can help determine if regular screening or preventative strategies are necessary. Level of evidence Level III.

show abstract

Section: Discussionmentioning

confidence: 99%

Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review

Vivekanantha

Diao

Cohen

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Failure of ACLR is not only attributed to graft diameter, with medial and lateral meniscus deiciency, non-anatomic femoral tunnel positioning, and younger patient age all being reported to play a role [14,27,28,34]. In addition, bone morphological risk factors such as increased tibial slope and intercondylar notch stenosis have also been shown to be associated with failure [7,10,12,31]. Increasing graft diameter is only one piece of the puzzle to optimize ACLR failure rates, and ive-strand hamstring autografts should be considered by surgeons in addition to controlling for other variables.…”

Section: Discussionmentioning

confidence: 99%

Though five‐strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four‐strand hamstring autograft preparations: a systematic review and meta‐analysis of level I and II studies

Vivekanantha,

Nedaie,

Grzela

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose To compare graft dimensions, functional outcomes, and failure rates following anterior cruciate ligament reconstruction (ACLR) with either ive-strand or four-strand hamstring autograft options. Methods Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 22 April 2023 for level I and II studies comparing ive-and four-strand hamstring autografts in ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details and rehabilitation, graft diameter, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot shift test, and graft rupture were extracted. PROMs included Knee Osteoarthritis and Outcome Score (KOOS) subscales, Lysholm, and International Knee Documentation Committee (IKDC). Results One randomized controlled trial (RCT) and four prospective cohort studies with 572 patients were included. Graft diameters were larger in the ive-strand group with a mean diference of 0.93 mm (95% CI 0.61 to 1.25, p < 0.001, I 2 = 66%). The ive-strand group reported statistically higher KOOS ADL subscale and Lysholm scores with a mean diference of 4.85 (95% CI 0.14 to 9.56, p = 0.04, I 2 = 19%) and 3.01 (95% CI 0.48 to 5.53, p = 0.02, I 2 = 0%), respectively. There were no differences in KOOS symptoms, pain, quality of life, or sports subscales, or IKDC scores. There were no diferences in rates of positive Lachman test, positive pivot shift test, or graft rupture with pooled odds ratios of 0.62 (95% CI 0.13 to 2.91, n.s., I 2 = 80%), 0.94 (95% CI 0.51 to 1.75, n.s., I 2 = 31%), and 2.13 (95% CI 0.38 to 12.06, n.s., I 2 = 0%), respectively. Conclusions Although ive-stranded hamstring autografts had signiicantly larger graft diameters compared to four-stranded grafts with a mean diference of 0.93 mm, similar graft rupture rates and clinical laxity assessments were identiied following ACLR. While some PROMs were statistically superior in the ive-stranded hamstring groups, the threshold for the minimal clinical important diference was not reached indicating similar clinical outcomes overall. Level of Evidence Level II.

show abstract

“…In this study, several bony morphological parameters were associated with knee kinematics during the double‐legged drop jump. Previous reports have shown that LPTS is a risk factor for high‐grade pivot shift [5, 22, 32], ACL injury [6, 27], and graft failure after ACL reconstruction [8, 41]. Regarding the knee kinematics, Hodel et al [18] reported that a steeper LPTS was not related to tibial anteroposterior translation or tibial rotation during level walking in 26 healthy volunteers imaged using dynamic video‐fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high‐demand activities

Nukuto,

Gale,

Yamamoto

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose Bony morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury. The relationship between bony morphology, knee kinematics, and ACL elongation during high-demand activities remains unclear. The purpose of this study was to determine if bone morphology features that have been associated with ACL injury risk and knee kinematics are also predictive of ACL elongation during fast running and double-legged drop jump. Methods Nineteen healthy athletes performed fast running and double-legged drop jump within a biplane radiography imaging system. Knee kinematics and ACL elongation were measured bilaterally after using a validated registration process to track bone motion in the radiographs and after identifying ACL attachment sites on magnetic resonance imaging (MRI). Bony morphological features of lateral posterior tibial slope (LPTS), medial tibial plateau (MTP) depth, and lateral femoral condyle anteroposterior width (LCAP)/lateral tibial plateau anteroposterior width (TPAP) were measured on MRI. Relationships between bony morphology and knee kinematics or ACL elongation were identiied using multiple linear regression analysis. ResultsNo associations between bony morphology and knee kinematics or ACL elongation were observed during fast running. During double-legged drop jump, a greater range of tibiofemoral rotation was associated with a steeper LPTS (β = 0.382, p = 0.012) and a deeper MTP depth (β = 0.331, p = 0.028), and a greater range of anterior tibial translation was associated with a shallower MTP depth (β = − 0.352, p = 0.018) and a larger LCAP/ TPAP (β = 0.441, p = 0.005); however, greater ACL elongation was only associated with a deeper MTP depth (β = 0.456, p = 0.006) at toe-of. Conclusion These indings indicate that observed relationships between bony morphology and kinematics should not be extrapolated to imply a relationship also exists between those bone morphology features and ACL elongation during highdemand activities. These new indings deepen our understanding of the relationship between bony morphology and ACL elongation during high-demand activities. This knowledge can help identify high-risk patients for whom additional procedures during ACL reconstruction are most appropriate.

show abstract

Elevated Posterior Tibial Slope Is Associated With Anterior Cruciate Ligament Reconstruction Failures: A Systematic Review and Meta-analysis

Cited by 12 publications

References 34 publications

Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review

Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review

Though five‐strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four‐strand hamstring autograft preparations: a systematic review and meta‐analysis of level I and II studies

Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high‐demand activities

Contact Info

Product

Resources

About