Posterior Tibial Slope in Anterior Cruciate Ligament Surgery: A Systematic Review

Mandalia, Vipul; Bayley, Morgan; Bhamber, Nivraj; Middleton, Simon; Houston, James

doi:10.1007/s43465-023-00947-x

Cited by 2 publications

(1 citation statement)

References 46 publications

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“…The 5°PTS angle represents the minimal average PTS based on the study by Medda et al [25]. The 14°option was chosen on the basis of the research by Matas et al on the upper limit of PTS [24] and by Mandalia et al [23] suggesting the danger of PTS values exceeding 12°.…”

Section: Methodsmentioning

confidence: 99%

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Kotiuk,

Ziółek,

Kostrub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to evaluate the impact of squats after the anterior cruciate ligament (ACL) reconstruction on the ACL graft, considering new data on biomechanics, posterior tibial slope (PTS) and anterolateral ligament (ALL).MethodsUtilising finite element analysis on the new 14‐component knee joint model, we have evaluated stresses on the knee elements separately for the knee with a native double‐bundle ACL and with a single‐bundle ACL graft for the 5° and 14° PTS variants during both conventional and Smith machine horizontal squats.ResultsReplacing a native ACL with a single‐bundle graft causes an overstrain on the graft compared to the intact ACL under all conditions. Stresses on the ACL, ACL graft and ALL are much higher during the Smith machine squats compared to the conventional ones. The stress on the menisci is 3.6–4.9 times higher with conventional squats. PTS at the squats' lowest point minimally affects ACL stress but impacts menisci.ConclusionsThe single‐bundle ACL reconstruction (ACLR) does not reproduce the biomechanics of the native ACL and increases stresses in most knee joint elements, according to the current study. Conventional squats are relatively safe for the ACL graft at their lowest point. Passing the half‐squat position is the most dangerous point. Smith machine horizontal squats produce stress on the ACL graft several times higher than its estimated breaking load and dangerous stress levels on the ALL. During the rehabilitation following ACLR, it is advisable to prioritise the conventional squats over Smith machine squats until ligamentisation is complete.Level of EvidenceLevel III.

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Section: Methodsmentioning

confidence: 99%

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Kotiuk,

Ziółek,

Kostrub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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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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Posterior Tibial Slope in Anterior Cruciate Ligament Surgery: A Systematic Review

Cited by 2 publications

References 46 publications

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative

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

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