Posterior tibial slope: the fingerprint of the tibial bone

Winkler, Philipp W.; Godshaw, Brian; Karlsson, Jón; Getgood, Alan; Musahl, Volker

doi:10.1007/s00167-021-06578-9

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…In further studies, a correlation between a steeper slope as measured in radiographs and ACL injuries in women (with noncontact injury mechanism) as well as children compered to nonruptured ACL group has already been established [ 33 , 34 ]. In addition, our results support the recommendation of Winkler et al to assess the tibial slope in both re-ruptured ACL and primary ACL ruptures [ 35 ]. The results of this paper indicate that it might not only be tibial slope in general but especially the tibial slope of the posterolateral quadrant, which could be a risk factor for an ACL injury.…”

Section: Discussionsupporting

confidence: 88%

Tibial slope in the posterolateral quadrant with and without ACL injury

Korthaus

Krause

Pagenstert

et al. 2021

Arch Orthop Trauma Surg

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Introduction An increased tibial slope is a risk factor for rupture of the anterior cruciate ligament. In addition, a tibial bone bruise or posterior lateral impression associated with slope changes also poses chronic ligamentous instability of the knee joint associated with an anterior cruciate ligament (ACL) injury. In the majority of cases, the slope is measured in one plane X-ray in the lateral view. However, this does not sufficient represent the complex anatomy of the tibial plateau and especially for the posterolateral quadrant. Normal values from a “healthy” population are necessary to understand if stability of the knee joint is negatively affected by an increasing slope in the posterolateral area. Until now there are no data about the physiological slope in the posterolateral quadrant of the tibial plateau. Materials and methods In 116 MRI scans of patients without ligamentous lesions and 116 MRI scans with an ACL rupture, tibial slope was retrospectively determined using the method described by Hudek et al. Measurements were made in the postero-latero-lateral (PLL) and postero-latero-central (PLC) segments using the 10-segment classification. In both segments, the osseous as well as the cartilaginous slope was measured. Measurements were performed by two independent surgeons. Results In the group without ligamentous injury the mean bony PLL slope was 5.8° ± 4.8° and the cartilaginous PLL slope was 6.7° ± 4.8°. In the PLC segment the mean bony slope was 6.6° ± 5.0° and the cartilaginous slope was 9.4° ± 5.7°. In the cohort with ACL rupture, the bony and cartilaginous slope in both PLL and PCL were significantly higher (P < 0.001) than in the group without ACL injury (bony PLL 9.8° ± 4.8°, cartilage PLL 10.4° ± 4.7°, bony PLC 10.3° ± 4.8°, cartilage PLL 12.8° ± 4.3°). Measurements were performed independently by two experienced surgeons. There were good inter- (CI 87–98.7%) and good intraobserver (CI 85.8–99.6%) reliability. Conclusion The bony and the cartilaginous slope in the posterolateral quadrant of the tibial plateau are different but not independent. Patients with an anterior cruciate ligament injury have a significantly steeper slope in the posterolateral quadrant compared to a healthy group. Our data indicate that this anatomic feature might be a risk factor for a primary ACL injury which has not been described yet. Level of evidence III.

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Section: Discussionsupporting

confidence: 88%

Tibial slope in the posterolateral quadrant with and without ACL injury

Korthaus

Krause

Pagenstert

et al. 2021

Arch Orthop Trauma Surg

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“…Most previous studies have shown that the PTS differs based on race and region [ 4 , 13 , 22 , 23 , 43 – 50 ]. We showed that, even if the same ATC measurement method is used, the measurement results still differ significantly (Table 6 ).…”

Section: Discussionmentioning

confidence: 99%

Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study

Chen

Ding

Dai

et al. 2022

BMC Musculoskelet Disord

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Background Measurement of the posterior tibial slope (PTS) angle has important applications in total knee replacement surgery, high tibial osteotomy, and anterior cruciate ligament reconstruction. This study aimed to determine the mean PTS of knee joints in healthy Chinese adults, and provide data to guide knee surgery in China. Methods A retrospective analysis of 1257 (n = 1233, 50.4% male) plain X-ray films of participants aged 25–59 years was performed. The picture archiving and communication system was used for PTS measurement. The PTS was defined as the angle between the vertical line of the tangent of the anterior tibial cortex of the proximal tibia, and the tangent line of the tibial cortex. Two imaging physicians conducted the PTS measurements independently, and both the inter- and intraclass correlation coefficients (ICCs) were calculated. Results The mean PTS value was 7.68 ± 3.84° (range: 0–21°). The left PTS was significantly smaller in males than in females (7.22 ± 3.89 vs 8.05 ± 3.60; P = 0.005). Additionally, the PTS in participants aged 25–29 years was significantly larger than that in the other age groups (Left side: 8.64 ± 3.73 vs 6.92 ± 3.42, 7.42 ± 3.75, 7.53 ± 3.98; P < 0.001 and Right side: 8.68 ± 3.84 vs 7.48 ± 4.21, 7.13 ± 3.64, 7.66 ± 3.80; P = 0.004). There were no significant differences in PTS between the left and right sides. Two-way analysis of variance suggested that the differences in PTS between age groups were not affected by sex. The interobserver ICC was 0.91 (95% confidence interval [CI]: 0.85–0.94), and the intraobserver ICC was 0.90 (95% CI: 0.82–0.94). Conclusions This study demonstrated that there were significant differences in PTS based on sex and age, highlighting the need to provide individualized treatment for knee surgery. It provided valuable information regarding the normal PTS values in Chinese adults and presented regionalised data to guide knee surgery.

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“…There is a growing body of evidence that the TS has a relevant impact on cruciate ligament strain, injury, and outcome after cruciate ligament reconstruction [24, 63]. But there is little information at which degree a slope‐reducing procedure should be performed, how it should be performed, and what TS alteration is appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the present cohort, seven patient underwent a previous lateral tenodesis and still suffered graft failure. Furthermore, it was suggested that in the primary setting, facing an outlier TS, a modification of the activity level should be discussed with the patient to prevent an osteotomy [63]. We believe that especially in young, active patients with a gross anterior instability and an outlier TS, the discussion might be hazardous for the survival of cartilage and menisci.…”

Section: Discussionmentioning

confidence: 99%

Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases

Weiler¹,

Gwinner

Wagner³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeIt has been proven that a steep tibial slope (TS) is a risk factor for anterior cruciate ligament (ACL) injury and graft insufficiency after ACL reconstruction (ACLR). Recently, there is an increasing number of case series on slope decreasing osteotomies after failed ACLR utilizing different techniques and strategies. Goal of the present study is to report on early experiences with slope decreasing osteotomies in ACL deficient knees with special emphasis on the amount of slope correction, technical details, and complications; and to further analyze differences of slope corrections between sole sagittal as well as combined coronal and sagittal realignment procedures. In addition, we wanted to study if sole sagittal corrections change the coronal alignment. MethodsSeventy‐six patients with a minimum follow‐up of 6 months were identified, who underwent a sole sagittal correction (anterior closed‐wedge high tibial osteotomy (ACW‐HTO)) or a combined procedure with an additional coronal realignment (medial open‐wedge high tibial osteotomy (MOW‐HTO)). In ACW‐HTO, either infratuberosity or supratuberosity approaches were used. The medial TS was measured on lateral radiographs and the anatomical medial proximal tibial angle (aMPTA) was measured on anterior–posterior radiographs. Technical details and specific complications were recorded. ResultsFifty‐eight ACW‐HTO and 18 MOW‐HTO were performed. Regarding ACW‐HTO, an infratuberosity (N = 48) or a supratuberosity (N = 10) approach was chosen. Sixty‐seven patients had at least 1 previous ACLR. Mean TS changed from 14.5 ± 2.2° to 6.8 ± 1.9° (P < 0.0001). Mean TS of ACW‐HTO was significantly reduced (14.6 ± 2.3° vs. 6.5 ± 1.9°; P < 0.0001), whereas in combined coronal and sagittal realignments, from 14.1 ± 1.9° to 7.6 ± 1.9° (P < 0.0001). The TS reduction in sole sagittal corrections was significantly higher compared to combined procedures (8.1 ± 1.6 vs. 6.4 ± 1.6°; P = 0.0002). Mean aMPTA in ACW‐HTO changed from 87.1 ± 2.1° to 87.4 ± 2.8 (n.s.). However, there was a significant inverse correlation between the amount of sagittal correction and coronal alteration (r = − 0.29; P = 0.028). There was one late implant infection, which occurred 5.5 months after the index surgery. ConclusionsACW‐HTO and MOW‐HTO facilitate significant slope reduction with a low‐risk profile in patients with ACL insufficiency and a high tibial slope. AOW‐HTO does not significantly alter coronal alignment in the majority of patients. Level of evidenceIV.

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Posterior tibial slope: the fingerprint of the tibial bone

Abstract: Life is most delightful on the downward slope." -Lucius Annaeus Seneca the Younger Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 7 publications

References 18 publications

Tibial slope in the posterolateral quadrant with and without ACL injury

Tibial slope in the posterolateral quadrant with and without ACL injury

Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study

Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases

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