Slippery Slope

Reider, Bruce

doi:10.1177/0363546519825850

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…They then suggested that tibial slope correction could be considered as early as the primary ACLR, agreeing with Song et al 47 Other authors only consider ACW-HTO for revision ACLRs. 1,41,49 This is in line with the authors’ opinion because of the complexity of the procedure, the risk of complications, and the lack of long-term clinical results in large series. The postoperative PTS target to be achieved is also debatable.…”

Section: Discussionsupporting

confidence: 78%

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The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

Guy,

Saithna,

Ferreira

et al. 2024

Am J Sports Med

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Background: A posterior tibial slope (PTS) >12° is an independent risk factor for anterior cruciate ligament (ACL) graft rupture, and a high tibial osteotomy (HTO) for slope correction can help avoid it. Management of patellar height is of major concern when performing HTO. Purpose: To evaluate the effect of tibial tubercle–sparing anterior closing-wedge osteotomy on patellar height in revision ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic revision ACLR combined with retro–tibial tubercle anterior closing-wedge HTO (ACW-HTO) between January 1, 2016, and March 31, 2021, were assessed for eligibility. Patellar height was measured on full weightbearing lateral radiographs according to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) or frontal radiographs using the femoral patellar height index. The PTS was evaluated using the proximal anatomic axis of the tibia on standard short lateral radiographs. The delta (postoperative – preoperative) and the ratio (preoperative/postoperative) of the 3 patellar height indices and PTS were calculated. Preoperative and postoperative patellar heights were compared using independent t tests for each index. Also investigated was whether patients changed patellar height category (baja, normal, or alta) after slope osteotomy. Results: Among 475 revision ACLRs, 47 tibial tubercle–sparing ACW-HTOs were retained for analysis. No significant difference in patellar height was found between pre- and postoperative radiographs regardless of the index (preoperative – postoperative) (ISI: 1.0 ± 0.2 – 0.9 ± 0.2, P = .1729; CDI: 1.0 ± 0.2 – 1.0 ± 0.2, P = .4034; femoral patellar height index: 1.5 ± 0.2 – 1.5 ± 0.2; P = .5130). Fifteen patients (31.9%) exhibited a postoperative change in their patellar height category when measured by the ISI (6 moved up a category, 9 moved down one), and 18 patients (38.3%) changed category according to the CDI (10 moved up a category, 8 moved down one). No significant difference was found between pre- and postoperative patellar height among these patients (ISI: P = .2418; CDI: P = .3005). Conclusion: Changes in patellar height ratio are common after tibial tubercle–sparing ACW-HTO in patients undergoing revision ACLR. The clinical effect of these changes is unknown, and further study is needed to investigate whether they may result in patellofemoral symptoms.

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Section: Discussionsupporting

confidence: 78%

“…The influence of the posterior tibial slope (PTS) on anterior cruciate ligament (ACL) injuries is well recognized. 41 Each additional degree of PTS increases the risk of recurrent ACL injury by 1.37-fold. 33 There is no clearly defined threshold beyond which a slope-reducing osteotomy should be considered in the revision ACL setting.…”

mentioning

confidence: 99%

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

Guy,

Saithna,

Ferreira

et al. 2024

Am J Sports Med

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“…Prior work has shown that increased posterior–inferior directed slope of the tibial plateau is associated with increased risk of suffering an ACL and ACL graft injury, and the increased lateral compartment posterior–inferior directed slopes found in the current study (3.6° for the ACL‐LM group and 1.6 for the ACL group) further exacerbates the chance of a second injury to the ACL graft . In addition, there is evidence that geometry of the articular cartilage and tibial plateau subchondral bone are associated with worsening cartilage degenerative changes in the lateral tibial plateau .…”

Section: Discussionsupporting

confidence: 51%

“…posterior-inferior directed slopes found in the current study (3.6°for the ACL-LM group and 1.6 for the ACL group) further exacerbates the chance of a second injury to the ACL graft. [24][25][26] In addition, there is evidence that geometry of the articular cartilage and tibial plateau subchondral bone are associated with worsening cartilage degenerative changes in the lateral tibial plateau. 27 Considered in combination, these findings introduce the hypothesis that once ACL injury has occurred, the same geometric characteristics associated with increased risk of suffering the index injury-increased posterior-inferior directed slope of the articular surfaces of the tibia 10,[17][18][19] -are also associated with increased risk of developing PTOA.…”

mentioning

confidence: 99%

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Beynnon

Fiorentino

Gardner‐Morse

et al. 2019

Journal Orthopaedic Research

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Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post‐traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage‐to‐bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759‐767, 2020

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“…A n increased posterior tibial slope (PTS) is a welldescribed anatomical risk factor for anterior cruciate ligament (ACL) graft rupture. [1][2][3][4] Webb et al described a threshold of 12 , after which a patient undergoing primary anterior cruciate ligament reconstruction (ACLR) has a 4.52-to 5.2-fold increased risk of graft rupture 5,6 and up to 11-fold in adolescents. 7 Cadaveric studies have demonstrated the direct correlation between an increased PTS steepness and ACL stress, intensified by sporting activities.…”

mentioning

confidence: 99%

Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees

Guy

Khakha

Ollivier

2022

Arthroscopy Techniques

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Slippery Slope

Cited by 6 publications

References 35 publications

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees

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