Lateral Tibial Posterior Slope Is Increased in Patients With Early Graft Failure After Anterior Cruciate Ligament Reconstruction

Christensen, Joshua; Krych, Aaron J.; Engasser, William M.; Vanhees, Matthias; Collins, Mark S.; Dahm, Diane L.

doi:10.1177/0363546515597664

Cited by 187 publications

(185 citation statements)

References 33 publications

(41 reference statements)

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“…[24] Also, there are anatomical and intrinsic risk factors that have not been discussed in this article because these factors are not subject to change by delaying a RTS. [122] We have presented the evidence in the literature showing that at 2 years after ACLR, biological healing (absence of bone bruises, ACL graft maturation, and sensory restoration) has occurred and functional recovery (biomechanical and neuromuscular control and quadriceps strength) of the knee has normalized or is not significantly different from baseline. Therefore, delaying a return to high level activity for high-risk athletes until two years after ACLR will restore knee joint homeostasis and significantly reduce the risk of subsequent injury.…”

Section: Discussionmentioning

confidence: 99%

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

2016

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Anterior cruciate ligament (ACL) tears are common knee injuries sustained by athletes during sports participation. A devastating complication of returning to sport following ACL reconstruction (ACLR) is a second ACL injury. Strong evidence now indicates that younger, more active athletes are at particularly high risk for a second ACL injury and this risk is greatest within the first two years following ACLR. Nearly one-third of the younger cohort that resumes sports participation will sustain a second ACL injury within the first two years after ACLR. The evidence indicates that the risk of second injury may abate over this time period. The incidence rate of second injuries in the first year after ACLR is significantly greater than the rate in the second year. The lower relative risk in the second year may be related to athletes achieving baseline joint health and function well after the current expected timeline (6 to 12 months) to be released to unrestricted activity. This highlights a considerable debate in the return to sport decision process as to whether an athlete should wait until two years after ACLR to return to unrestricted, sports activity. In this review, we present evidence in the literature that athletes achieve baseline joint health and function approximately two years after ACLR. We postulate that delay in returning to sports for nearly two years will significantly reduce the incidence of second ACL injuries.

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Section: Discussionmentioning

confidence: 99%

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

2016

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“…51 These predicted alterations to landing mechanics add to the justification of why CPTS correlated with change in ACL strain when the present specimens were parsed out by sex. 15 …”

Section: Discussionmentioning

confidence: 99%

“…28, 67 Greater medial compartment posterior tibial slope angle (MPTS) and lateral compartment posterior tibial slope angle (LPTS) have been associated with increased ACL injury risk, 60, 61 and graft failure following ACL reconstruction. 15 Steeper tibial slope angles can increase anterior tibial translation during direct compressive loading of the knee as the loading forces drive the femur down the tibial slope and shift the tibiofemoral contact locations in a posterior direction on the tibial plateau. 16, 21 As the ACL is the primary passive restraint against anterior tibial translation, 14, 17, 24 increased translation has been shown to subsequently induce greater mechanical demand on the ACL throughout flexion.…”

Section: Introductionmentioning

confidence: 99%

External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings

Bates

Jaramillo

Vargas

et al. 2019

Clinical Biomechanics

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Background: The aim of the present study was to evaluate the relationship between tibial slope angle and ligament strain during in vitro landing simulations that induce ACL failure through the application of variable external loading at the knee. The hypothesis tested was that steeper posterior tibial slope angle would be associated with higher ACL strain during a simulated landing task across all external loading conditions. Methods: Kinetics previously derived from an in vivo cohort performing drop landings were reproduced on 45 cadaveric knees via the mechanical impact simulator. MRIs were taken of each specimen and used to calculate medial compartment posterior tibial slope, lateral compartment posterior tibial slope, and coronal plane tibial slope. Linear regression analyses were performed between these angles and ACL strain to determine whether tibial slope was a predictive factor for ACL strain. Findings: Medial and lateral posterior tibial slope were predictive factors for ACL strain during some landings with higher combined loads. Medial posterior slope was more predictive of ACL strain in most landings for male specimens, while lateral posterior and coronal slope were more predictive in female specimens, but primarily when high abduction moments were applied. Interpretation: Tibial slope has the potential to influence ACL strain during landing, especially when large abduction moments are present at the knee. Deleterious external loads to the ACL increase the correlation between tibial slope and ACL strain, which indicates that tibial slope angles are an additive factor for athletes apt to generate large out-of-plane knee moments during landing tasks.

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“…24,25 Specifically, a meta-analysis demonstrated increased posterior tibial slope in patients with ACL injury compared with uninjured knees. 26 Christensen et al 27 compared patients with early ACL graft failure with a control group of patients with successful ACL reconstruction and also found significantly increased slope in patients who had failed (8.4 v 6.5 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Risk Factors of Rerevision Anterior Cruciate Ligament Reconstruction: A Systematic Review

Liechti

Chahla

Dean

et al. 2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Lateral Tibial Posterior Slope Is Increased in Patients With Early Graft Failure After Anterior Cruciate Ligament Reconstruction

Abstract: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.

Cited by 187 publications

References 33 publications

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings

Outcomes and Risk Factors of Rerevision Anterior Cruciate Ligament Reconstruction: A Systematic Review

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