High variability of tibial slope measurement methods in daily clinical practice: Comparisons between measurements on lateral radiograph, magnetic resonance imaging, and computed tomography

Naendrup, Jan‐Hendrik; Drouven, Sabrina; Shaikh, Humza S.; Jaecker, Vera; Offerhaus, Christoph; Shafizadeh, Sven; Pfeiffer, Thomas

doi:10.1016/j.knee.2020.01.013

Cited by 28 publications

(37 citation statements)

References 17 publications

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“…6,43 A significant degree of variability has been reported between different imaging (ie, plain radiographs, computed tomography scans, and MRI scans) and measurement methods of the tibial slope. 19,33 Accordingly, in our study, the medial tibial slope was relatively lower compared with those of previous reports. Interestingly, again, in our study, the medial tibial slope did not appear as a significant independent risk factor for ACL injury under the standard statistical analysis.…”

Section: Anatomic Features Of the Kneecontrasting

confidence: 64%

A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

Tamimi

Ballesteros

Lara

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Supervised machine learning models in artificial intelligence (AI) have been increasingly used to predict different types of events. However, their use in orthopaedic surgery has been limited. Hypothesis: It was hypothesized that supervised learning techniques could be used to build a mathematical model to predict primary anterior cruciate ligament (ACL) injuries using a set of morphological features of the knee. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 adults who had undergone primary ACL reconstruction between 2008 and 2015. All patients were between 18 and 40 years of age at the time of surgery. Patients with a previous ACL injury, multiligament knee injury, previous ACL reconstruction, history of ACL revision surgery, complete meniscectomy, infection, missing data, and associated fracture were excluded. We also identified 50 sex-matched controls who had not sustained an ACL injury. For all participants, we used the preoperative magnetic resonance images to measure the anteroposterior lengths of the medial and lateral tibial plateaus as well as the lateral and medial bone slope (LBS and MBS), lateral and medial meniscal height (LMH and MMH), and lateral and medial meniscal slope (LMS and MMS). The AI predictor was created using Matlab R2019b. A Gaussian naïve Bayes model was selected to create the predictor. Results: Patients in the ACL injury group had a significantly increased posterior LBS (7.0° ± 4.7° vs 3.9° ± 5.4°; P = .008) and LMS (–1.7° ± 4.8° vs –4.0° ± 4.2°; P = .002) and a lower MMH (5.5 ± 0.1 vs 6.1 ± 0.1 mm; P = .006) and LMH (6.9 ± 0.1 vs 7.6 ± 0.1 mm; P = .001). The AI model selected LBS and MBS as the best possible predictive combination, achieving 70% validation accuracy and 92% testing accuracy. Conclusion: A prediction model for primary ACL injury, created using machine learning techniques, achieved a >90% testing accuracy. Compared with patients who did not sustain an ACL injury, patients with torn ACLs had an increased posterior LBS and LMS and a lower MMH and LMH.

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Section: Anatomic Features Of the Kneecontrasting

confidence: 64%

A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

Tamimi

Ballesteros

Lara

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…In their study comparing different imaging methods, Naendrup et al stated that the main limitation was not being able to exclude the effects of rotation defects, whereas we found that it is possible to minimize the measurement errors caused by rotation by using all axes when applying MPR [ 30 ].…”

Section: Discussionmentioning

confidence: 98%

“…In 2020, Naendrup et al evaluated the correlations among radiography, MRI, and CT measurements of PTS [30]. There was a high degree of variability among, and inaccuracy in, the three imaging methods [16].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, except for prospective diagnostic purposes, it is unethical to expose a patient to additional X-ray radiation or CT scans. In 2020, Naendrup et al evaluated the correlations among radiography, MRI, and CT measurements of PTS [ 30 ]. There was a high degree of variability among, and inaccuracy in, the three imaging methods [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, as this was a retrospective study, the measurements could not be compared to X-ray or MRI images of the same patients. Different imaging modalities and methods for measuring the PTS yield different values, i.e., there are discrepancies among methods [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Posterior Tibial Slope and a New Morphometric Method With Multiplanar Reconstruction Technique in a Turkish Sample

Kaçmaz¹,

Er²,

Basa³

et al. 2021

Cureus

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Aim: The posterior tibial slope (PTS) is important in planning many orthopedic procedures. The aim of the study is to outline a PTS measurement method using multiplanar reconstruction (MPR) in knee computed tomography (CT) images. Methods: MPR reconstruction was performed on pre-captured CT angio images of 124 patients. A standard tibial axis was created. Then, using reference points, the PTS was measured separately for the medial PTS (MPTS) and lateral PTS (LPTS). To identify an intra-and interobserver error, the technical error of measurement (TEM), relative TEM (rTEM), and coefficient of reliability (R) of the measurement were analyzed.Results: The study enrolled 124 patients (88 males, 36 females) from 18 to 92 years old. The average MPTS 8.63 ± 2.7° and LPTS 7.77 ± 3.1° were significantly different (p < 0.05). However, there was no difference between the sexes (p = 0.52 for MPTS; p = 0.9 for LPTS). The R for intraobserver reliability was 0.942 for the MPTS and 0.943 for the LPTS, and that for interobserver reliability was 0.815 and 0.806, respectively.Conclusions: PTS measurement from CT images appears advantageous as it eliminates measurement limitations due to tibial rotation and has high intra-and interobserver consistency.

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Malrotated lateral knee radiographs do not allow for a proper assessment of medial or lateral posterior tibial slope

Vieider,

Mehl,

Rab

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to investigate whether malrotation of lateral knee radiographs influences posterior tibial slope (PTS) measurements.MethodsLateral knee radiographs of all patients who underwent knee surgery at a single institution between June 2022 and January 2023 and received multiple lateral knee radiographs were included. Radiographs were categorised as malrotated lateral knee radiographs or lateral knee radiographs based on the radiographic distance between the medial and lateral posterior femoral condyles. Medial PTS (MPTS) and lateral PTS (LPTS) were evaluated on malrotated lateral knee radiographs and lateral knee radiographs and compared using the paired t test. Intra‐ and interrater reliability between four raters were assessed for MPTS and LPTS measurements.ResultsA total of 92 lateral knee radiographs (46 pairs of malrotated lateral knee radiographs and lateral knee radiographs; 50.0% right side) from 46 patients (33.2 ± 12.4 years, 69.6% male) were included. Mean posterior femoral condyle distance in malrotated lateral knee radiographs was 8.1 ± 4.4 mm. Overall, MPTS and LPTS were significantly higher on malrotated lateral knee radiographs versus lateral knee radiographs (medial: 10.5 ± 3.2° vs. 9.7 ± 3.5°, p < 0.05; lateral: 10.6 ± 3.4° vs. 9.7 ± 3.3°, p < 0.05). Mean absolute difference between MPTS and LPTS on malrotated lateral knee radiographs versus lateral knee radiographs were |1.9| ± |1.5|° and |2.0| ± |1.8|°, respectively. Intrarater reliability was ‘moderate’ and interrater reliability was ‘good’ for both MPTS and LPTS.ConclusionMalrotation of lateral knee radiographs led to a significant distortion of both the MPTS and LPTS. In clinical practice, attention should be placed on the (mal)rotation of lateral knee radiographs, especially in patients for whom a slope‐correcting osteotomy is being discussed.Level of EvidenceLevel IV.

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High variability of tibial slope measurement methods in daily clinical practice: Comparisons between measurements on lateral radiograph, magnetic resonance imaging, and computed tomography

Cited by 28 publications

References 17 publications

A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

Posterior Tibial Slope and a New Morphometric Method With Multiplanar Reconstruction Technique in a Turkish Sample

Malrotated lateral knee radiographs do not allow for a proper assessment of medial or lateral posterior tibial slope

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