Patients With Failed Anterior Cruciate Ligament Reconstruction Have an Increased Posterior Lateral Tibial Plateau Slope: A Case-Controlled Study

Grassi, Alberto; Signorelli, Cecilia; Urrizola, Francisco; Macchiarola, Luca; Raggi, Federico; Mosca, Massimiliano; Samuelsson, Kristian; Zaffagnini, Stefano

doi:10.1016/j.arthro.2018.11.049

Cited by 61 publications

(65 citation statements)

References 36 publications

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“… 3 , 4 , 5 In fact, a recent study by Grassi et al. 4 has shown that the most accurate predictor of ACL graft failure was a steep PLTP slope measuring greater than 7.4°. Therefore, in cases of PLTP fracture occurring in the context of a “high-energy ACL” injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL.…”

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confidence: 99%

“…A growing body of literature has demonstrated the association between steep posterior tibial plateau slope with an increased risk of ACL rupture, [2][3][4] as well as a significantly increased risk of graft failure of the reconstructed ACL. [3][4][5] In fact, a recent study by Grassi et al 4 has shown that the most accurate predictor of ACL graft failure was a steep PLTP slope measuring greater than 7.4 . Therefore, in cases of PLTP fracture occurring in the context of a "high-energy ACL" injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL.…”

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confidence: 99%

“…Therefore, in cases of PLTP fracture occurring in the context of a "high-energy ACL" injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL. [4][5][6][7][8][9][10] Presently, there is no consensus on the optimal timing or a gold-standard surgical procedure for this type of tibial plateau fractures associated with "high-energy ACL" injuries. 1,11 This necessitates surgical innovation and development of a procedure that maximizes postoperative functional outcome while minimizing the duration of discomfort and morbidity associated with operative management.…”

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confidence: 99%

“…A growing body of literature has demonstrated the association between steep posterior tibial plateau slope with an increased risk of ACL rupture, 2 , 3 , 4 as well as a significantly increased risk of graft failure of the reconstructed ACL. 3 , 4 , 5 In fact, a recent study by Grassi et al. 4 has shown that the most accurate predictor of ACL graft failure was a steep PLTP slope measuring greater than 7.4°.…”

mentioning

confidence: 99%

“…Therefore, in cases of PLTP fracture occurring in the context of a “high-energy ACL” injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL. 4 , 5 , 6 , 7 , 8 , 9 , 10 …”

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confidence: 99%

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An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

Park

Laverdière

Corban

et al. 2020

Arthroscopy Techniques

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High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

Park

Laverdière

Corban

et al. 2020

Arthroscopy Techniques

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Enhanced reliability and time efficiency of deep learning‐based posterior tibial slope measurement over manual techniques

Yao,

Zhang,

Podder

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeMultifaceted factors contribute to inferior outcomes following anterior cruciate ligament (ACL) reconstruction surgery. A particular focus is placed on the posterior tibial slope (PTS). This study introduces the integration of machine learning and artificial intelligence (AI) for efficient measurements of tibial slopes on magnetic resonance imaging images as a promising solution. This advancement aims to enhance risk stratification, diagnostic insights, intervention prognosis and surgical planning for ACL injuries.MethodsImages and demographic information from 120 patients who underwent ACL reconstruction surgery were used for this study. An AI‐driven model was developed to measure the posterior lateral tibial slope using the YOLOv8 algorithm. The accuracy of the lateral tibial slope, medial tibial slope and tibial longitudinal axis measurements was assessed, and the results reached high levels of reliability. This study employed machine learning and AI techniques to provide objective, consistent and efficient measurements of tibial slopes on MR images.ResultsThree distinct models were developed to derive AI‐based measurements. The study results revealed a substantial correlation between the measurements obtained from the AI models and those obtained by the orthopaedic surgeon across three parameters: lateral tibial slope, medial tibial slope and tibial longitudinal axis. Specifically, the Pearson correlation coefficients were 0.673, 0.850 and 0.839, respectively. The Spearman rank correlation coefficients were 0.736, 0.861 and 0.738, respectively. Additionally, the interclass correlation coefficients were 0.63, 0.84 and 0.84, respectively.ConclusionThis study establishes that the deep learning‐based method for measuring posterior tibial slopes strongly correlates with the evaluations of expert orthopaedic surgeons. The time efficiency and consistency of this technique suggest its utility in clinical practice, promising to enhance workflow, risk assessment and the customization of patient treatment plans.Level of EvidenceLevel III, cross‐sectional diagnostic study.

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Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

Bai,

Zhang,

Hong

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL−M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure.MethodsPubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random‐effects model was employed to calculate the overall standardized mean difference between the two groups.ResultsA total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL−M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL−M (p = 0.039) compared to the control group.ConclusionIncreased ATS and ATSL−M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR.Level of EvidenceLevel III.

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Patients With Failed Anterior Cruciate Ligament Reconstruction Have an Increased Posterior Lateral Tibial Plateau Slope: A Case-Controlled Study

Cited by 61 publications

References 36 publications

An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

Enhanced reliability and time efficiency of deep learning‐based posterior tibial slope measurement over manual techniques

Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

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