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CC BY 4.0 · Surg J (N Y) 2018; 04(03): e152-e159
DOI: 10.1055/s-0038-1668111
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Ratio of Tibial Slope and Meniscal Bone Angle for the Prediction of ACL Reconstruction Failure Risk

Steffen Sauer
1   Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
,
Robert English
2   Department of Orthopaedic Surgery, Middlemore Hospital, The University of Auckland, Auckland, New Zealand
,
Mark Clatworthy
2   Department of Orthopaedic Surgery, Middlemore Hospital, The University of Auckland, Auckland, New Zealand
› Author Affiliations
Further Information

Publication History

09 May 2018

03 July 2018

Publication Date:
20 August 2018 (online)

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Abstract

Background A growing body of research is indicating that the tibial slope and the geometry of the tibiofemoral meniscal–cartilage interface may affect the risk of anterior cruciate ligament reconstruction (ACLR) failure. Increased lateral tibial posterior slope (LTPS) and reduced meniscal bone angle (MBA) are associated with increased risk of anterior cruciate ligament (ACL) injury. The significance of a LTPS–MBA ratio regarding the prediction of ACL failure risk remains unknown. As LTPS and MBA may eventually potentiate or neutralize each other, it is expected that a low LTPS–MBA ratio is associated with high chance of ACL graft survival while a high LTPS–MBA ratio is associated with high risk of ACL failure.

Material and Methods Out of 1,487 consecutive patients who underwent hamstring ACLR between August 2000 and May 2013, 54 ACLR failures with intact lateral menisci were included in this study and matched one-to-one with 54 control participants by age, sex, graft, surgical technique, and graft fixation method. Control participants had undergone ACLR without signs of lateral meniscal injury, graft failure, or insufficiency. MBA and LTPS were assessed on magnetic resonance imaging. Logistic regression was used to identify LTPS/MBA key cut-off ratios.

Results In this cohort, a LTPS–MBA ratio under 0.27 was associated with a 28% risk of ACLR failure (36% of patients), while a ratio exceeding 0.42 was associated with an 82% risk of ACLR failure (31% of patients). The odds of ACL failure increased by 22.3% per reduction of 1 degree in MBA (odds ratio [OR], 1.22; 95% limits, 1.1–1.34). No significant association was found between LTPS and the risk of ACL graft failure in transtibial ACLR, while the odds of ACL failure increased by 34.9% per degree of increasing LTPS in transportal ACLR (OR, 1.34; 95% limits, 1.01–1.79). No significant correlation was found between MBA and LTPS (p = 0.5).

Conclusion Reduced MBA was associated with significantly increased risk of ACL graft failure. A ratio of LTPS and MBA was found to be useful for the prediction of ACLR failure risk and may preoperatively help to identify patients at high risk of ACLR failure. This may have implications for patient counseling and the indication of additional extra-articular stabilizing procedures.

Keywords

ACL - tibial slope - LTPS - MBA - FMIA - meniscal bone angle
 

  • References

  • 1 Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2009; 17 (02) 117-124
    CrossrefPubMedGoogle Scholar
  • 2 Mahmoud SS, Odak S, Coogan S, McNicholas MJ. A prospective study to assess the outcomes of revision anterior cruciate ligament reconstruction. Int Orthop 2014; 38 (07) 1489-1494
    CrossrefPubMedGoogle Scholar
  • 3 Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 2008; 36 (02) 308-315
    CrossrefPubMedGoogle Scholar
  • 4 Grood ES, Suntay WJ, Noyes FR, Butler DL. Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am 1984; 66 (05) 725-734
    CrossrefPubMedGoogle Scholar
  • 5 Khan MS, Seon JK, Song EK. Risk factors for anterior cruciate ligament injury: assessment of tibial plateau anatomic variables on conventional MRI using a new combined method. Int Orthop 2011; 35 (08) 1251-1256
    CrossrefPubMedGoogle Scholar
  • 6 Levy IM, Torzilli PA, Gould JD, Warren RF. The effect of lateral meniscectomy on motion of the knee. J Bone Joint Surg Am 1989; 71 (03) 401-406
    CrossrefPubMedGoogle Scholar
  • 7 Myer GD, Ford KR, Paterno MV, Nick TG, Hewett TE. The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. Am J Sports Med 2008; 36 (06) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 8 Getgood AM, Lording T, Corbo G, Burkhart TA. The synergistic role of the lateral meniscus posterior root and the all in providing anterolateral rotational stability of the knee. Orthop J Sports Med 2016;4(07):
    PubMedGoogle Scholar
  • 9 Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 2009; 467 (08) 2066-2072
    CrossrefPubMedGoogle Scholar
  • 10 Sturnick DR, Vacek PM, DeSarno MJ. , et al. Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females. Am J Sports Med 2015; 43 (04) 839-847
    CrossrefPubMedGoogle Scholar
  • 11 Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS, Dahm DL. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med 2015; 43 (10) 2510-2514
    CrossrefPubMedGoogle Scholar
  • 12 Fukubayashi T, Torzilli PA, Sherman MF, Warren RF. An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Joint Surg Am 1982; 64 (02) 258-264
    CrossrefPubMedGoogle Scholar
  • 13 Hashemi J, Chandrashekar N, Gill B. , et al. The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am 2008; 90 (12) 2724-2734
    CrossrefPubMedGoogle Scholar
  • 14 Hashemi J, Chandrashekar N, Mansouri H. , et al. Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 2010; 38 (01) 54-62
    CrossrefPubMedGoogle Scholar
  • 15 McLean SG, Lucey SM, Rohrer S, Brandon C. Knee joint anatomy predicts high-risk in vivo dynamic landing knee biomechanics. Clin Biomech (Bristol, Avon) 2010; 25 (08) 781-788
    CrossrefPubMedGoogle Scholar
  • 16 Shao Q, MacLeod TD, Manal K, Buchanan TS. Estimation of ligament loading and anterior tibial translation in healthy and ACL-deficient knees during gait and the influence of increasing tibial slope using EMG-driven approach. Ann Biomed Eng 2011; 39 (01) 110-121
    CrossrefPubMedGoogle Scholar
  • 17 Li Y, Hong L, Feng H. , et al. Posterior tibial slope influences static anterior tibial translation in anterior cruciate ligament reconstruction: a minimum 2-year follow-up study. Am J Sports Med 2014; 42 (04) 927-933
    CrossrefPubMedGoogle Scholar
  • 18 Robb C, Kempshall P, Getgood A. , et al. Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3683-3690
    CrossrefPubMedGoogle Scholar
  • 19 Wordeman SC, Quatman CE, Kaeding CC, Hewett TE. In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 2012; 40 (07) 1673-1681
    CrossrefPubMedGoogle Scholar
  • 20 Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM. Association between lateral posterior tibial slope, body mass index, and ACL injury risk Ortop. Orthop J Sports Med 2017; 5 (02) 2325967116688664
    CrossrefPubMedGoogle Scholar
  • 21 Moatshe G, Chahla J, Slette E, Engebretsen L, Laprade RF. Posterior meniscal root injuries. Acta Orthop 2016; 87 (05) 452-458
    CrossrefPubMedGoogle Scholar
  • 22 Feucht MJ, Bigdon S, Bode G. , et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg 2015; 10: 34
    CrossrefPubMedGoogle Scholar
  • 23 Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med 2013; 41 (12) 2800-2804
    CrossrefPubMedGoogle Scholar
  • 24 Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC. Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 2013; 29 (01) 98-105
    CrossrefPubMedGoogle Scholar
  • 25 Shelburne KB, Kim HJ, Sterett WI, Pandy MG. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 2011; 29 (02) 223-231
    CrossrefPubMedGoogle Scholar
  • 26 Shultz SJ, Schmitz RJ. Tibial plateau geometry influences lower extremity biomechanics during landing. Am J Sports Med 2012; 40 (09) 2029-2036
    CrossrefPubMedGoogle Scholar
  • 27 Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech 2010; 43 (09) 1702-1707
    CrossrefPubMedGoogle Scholar
  • 28 Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med 1993; 21 (04) 535-539
    CrossrefPubMedGoogle Scholar
  • 29 Wasserstein D, Khoshbin A, Dwyer T. , et al. Risk factors for recurrent anterior cruciate ligament reconstruction: a population study in Ontario, Canada, with 5-year follow-up. Am J Sports Med 2013; 41 (09) 2099-2107
    CrossrefPubMedGoogle Scholar
  • 30 Hudek R, Fuchs B, Regenfelder F, Koch PP. Is noncontact ACL injury associated with the posterior tibial and meniscal slope?. Clin Orthop Relat Res 2011; 469 (08) 2377-2384
    CrossrefPubMedGoogle Scholar
  • 31 Cho S, Ko S, Woo JK. Meniscus-stabilizing function of the meniscofemoral ligament: experimental study of pig knee joints. Arthroscopy 2006; 22 (08) 872-877
    CrossrefPubMedGoogle Scholar
  • 32 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184 (05) 564-569
    PubMedGoogle Scholar
  • 33 Sonnery-Cottet B, Mogos S, Thaunat M. , et al. Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42 (08) 1873-1880
    CrossrefPubMedGoogle Scholar