Medial Tibial Plateau Depth Research Articles

Risk-factor analysis of the proximal tibia morphology for secondary ipsilateral injury after anterior cruciate ligament reconstruction: A retrospective cross-sectional study.

Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904-5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.

A larger radius of the medial femoral posterior condyle is a risk factor for medial meniscus posterior root tears

BackgroundStudies have shown an association between medial meniscus posterior root tears (MMPRT) and morphologic characteristics of the bone. However, the association between distal femoral bone morphology and MMPRT, particularly the medial femoral posterior condyle, is poorly understood. Our study aimed to determine the association between the morphologic characteristics of the medial posterior femoral condyle and MMPRT.MethodsA retrospective case-control study was performed from January 2021 to January 2022. After screening based on the inclusion and exclusion criteria, two matched groups were analyzed: the MMPRT group and the isolated lateral meniscus tears group. The hip-knee-ankle angle (HKA) and Kellgren-Lawrence grade (KLG) were measured on radiographs; the medial tibial slope angle (MTSA), medial tibial plateau depth (MTPD), and radius of the medial femoral posterior condyle (RMFPC) were measured on magnetic resonance imaging (MRI) in both groups. The area under the curve (AUC) and the best cutoff value for predicting MMPRT were calculated by using receiver operating characteristic (ROC) curve analysis.ResultsThe final analysis included a total of 174 patients (87 MMPRT patients and 87 controls). Significant differences were shown in the RMFPC (17.6 ± 1.0 vs. 16.2 ± 1.0, p < 0.01) and MTSA (6.4 ± 2.0 vs. 4.0 ± 1.3, p < 0.01), which were larger than those of the control group. The MTPD (1.8 ± 0.6 vs. 2.9 ± 0.7, p < 0.01) and HKA (175.4 ± 2.2 vs. 179.0 ± 2.7, p < 0.01) of the injury group were significantly different from the control group, and both were lower than the control group. However, between the MMPRT and control groups on the KLG (2.3 ± 0.6 vs. 2.2 ± 0.6, p = 0.209), there was no statistically significant difference. Among them, the RMFPC cutoff value was calculated to be 16.8 mm by ROC curve analysis, and the sensitivity and specificity were both 81.61%.ConclusionsThis study demonstrated that larger RMFPC, MTSA, smaller MTPD, and HKA were all associated with MMPRT, and RMFPC ≥ 16.8 mm was considered as a significant risk factor for MMPRT.

Investigation of the anatomic risk factors in acute anterior cruciate ligament ruptures to develop ramp lesions of the medial meniscus by quantitative MRI

ObjectiveTo investigate the anatomic risk factors of knee in patients with acute non-contact anterior cruciate ligament (aACL) ruptures to develop ramp lesions.MethodsA total of 202 subjects were retrospectively divided into three groups: (1) aACL ruptures combined with ramp lesions group (n = 76); (2) isolated ACL ruptures group (n = 56) and (3) normal controls group (n = 70). Quantitative morphological parameters on MRI were measured including: diameter of medial femoral condyle (MFC), anterior-posterior length and depth of medial tibial plateau (MTP AP length and depth), lateral posterior tibial slope (LPTS) and medial posterior tibial slope (MTPS), asymmetry of LPTS and MPTS (LMPTS), lateral meniscal slope (LMS), and medial meniscal slope (MMS).ResultsThe MTP AP length, MTP AP length/MFC diameter ratio, MTP depth, LPTS and the asymmetry of LMPTS showed significant differences among the three groups (p < 0.001). The risk factors associated with the ramp lesions including a longer MTP AP length (OR 1.17, 95% CI 1.00–1.44, p = 0.044), increased MTP depth (OR 1.91, 95% CI 1.22–3.00, p = 0.005) and lager ratio (OR 1.11, 95% CI 1.01–1.22, p = 0.036). The highest AUC was the MTP AP length/MFC diameter ratio (0.74; 95% CI, 0.66–0.82). The combination model increased higher accuracy (0.80; 95% CI, 0.72–0.88).ConclusionSeveral bony anatomic characteristics of the knee, especially the morphology of medial tibia plateau, are additional risk factors for aACL ruptures to develop ramp lesions.Critical relevance statementPredictive anatomic risk factors of the knee for patients with acute non-contact anterior cruciate ligament (aACL) ruptures to develop ramp lesions, especially the morphology of medial tibia plateau, are detectable by MRI.Key PointsRamp lesion development can complicate aACL ruptures and requires specific treatment.Longer AP length and increased MTP depth are risk factors for concurrent ramp lesions.Identification of ramp lesions allows for the most appropriate treatment.Graphical

Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of solitary meniscus injury.

Background: Past studies found that an increased lateral femoral condyle ratio is associated with anterior cruciate ligament injuries, but it is not clear if there is a link between MRI-measured lateral femoral condyle ratios and meniscal injuries. MRI provides a more accurate selection of measurement planes. Compared to X-rays, it further reduces data errors due to non-standard positions. Objective: To study the relationship between knee bone morphology and Solitary meniscal injuries by MRI. Methods: A total of 175 patients were included in this retrospective case-control study, including 54 cases of pure medial meniscus injury, 44 cases of pure lateral meniscus injury as the experimental group, and 77 control subjects. MRI images were used to measure the femoral notch width, femoral condylar width, femoral notch width index, lateral femoral condylar ratio (LFCR), posterior tibial slope, medial tibial plateau depth, and meniscus slope. In addition, carefully check for the presence of specific signs such as bone contusions and meniscal extrusions. Comparing the anatomical differences in multiple bone morphologies between the two groups, a stepwise forward multifactorial logistic analysis was used to identify the risk factors for Solitary meniscal injuries. Finally, ROC curves were used to determine the critical values and best predictors of risk factors. Results: MTS, LTS, and LFCR ended up as independent risk factors for meniscus injury. Among all risk factors, LFCR had the largest AUC of 0.781 (0.714-0.848) with a threshold of 72.75%. When combined with MTS (>3.63°), diagnostic performance improved with an AUC of 0.833 (0.774-0.892). Conclusion: Steep medial tibial plateau slope, steep lateral tibial plateau slope angle, and deep posterior lateral femoral condyles on MRI are independent risk factors for meniscal injuries. In patients with knee discomfort with the above imaging findings (X-ray, MRI), we should suspect and carefully evaluate the occurrence of meniscal injuries. It not only provides a theoretical basis to understand the mechanism of meniscus injury but also provides theoretical guidance for the prevention of meniscus injury and the development of intervention measures. Level of evidence III.

Anterior cruciate ligament (ACL) injury: correlation with MRI morphometry

BackgroundThis study aims to investigate the association between bony morphological features and ACL injury and to identify potential risk factors for the identification and prevention of ACL injuries. The study used knee MRIs to examine the distal femoral and proximal tibia morphology of 500 patients aged 19–50, including 250 cases with an injured ACL and 250 controls with a non-injured ACL. Previous literature has shown that ACL injuries are a common occurrence in sports and can have serious long-term consequences. Several risk factors have been identified, including anatomical variations in the bony structures of the knee. However, the relationship between bony morphology and ACL injury is not well understood, and there is a need to investigate the potential role of these factors in the identification and prevention of ACL injuries. This study was necessary because of the high incidence of ACL injuries and the potential long-term consequences, such as osteoarthritis, associated with this injury. By identifying potential risk factors, such as bony morphological features, it may be possible to develop targeted prevention strategies to reduce the incidence of ACL injuries. The study also adds to the existing literature by providing new insights into the relationship between bony morphology and ACL injury, and by identifying specific parameters that can be used to predict ACL injury. ResultsThere was a significant difference in bony morphology between ACL-injured and non-injured patients. The most convincing parameters of femur and tibia were notch width index (NWI), medial tibial plateau depth (MTPD), and lateral tibial plateau slope (LTPS). A significantly smaller intercondylar notch was seen in the injured patients (mean 17.25 mm) than in controls (mean 18.41 mm) (p < 0.001, unpaired t test). The findings indicate that among all the features assessed, the medial tibial plateau depth (MTPD) stands out as the most statistically significant with an odds ratio of 2.4, and it demonstrates a substantial association.ConclusionsACL-injured patients have a narrower NWI, shallower MTPD, and steeper LTPS, which appear to be associated with ACL injury. Identifying the cut-off values for these parameters can help predict ACL injury.

MRI correlation of anterior cruciate ligament injuries with Femoral Intercondylar Notch, Posterior Tibial Slopes and Medial Tibial Plateau Depth

Background: Knee joint is one of the largest joints in the body which solely is responsible for supporting the foremost weight of the body. Anterior Cruciate Ligament plays a primary role in stabilizing the knee joints, which also increases its chances of risk. Therefore, in comparison to other ligaments Anterior Cruciate Ligament injury can more commonly lead to knee instability. Aims &amp; Objectives. To study and correlate femoral intercondylar notch width and shape on Magnetic Resonance Imaging in Anterior Cruciate Ligament injuries. Further, to study relationship of posterior tibial slopes of medial and lateral plateaus and depth of the medial tibial plateau with Anterior Cruciate Ligament injury on Magnetic Resonance Imaging. Materials &amp; Methods: Patients with clinical suspicion of Anterior Cruciate Ligament injury undergoing Magnetic Resonance Imaging knee at M.S. Ramaiah hospitals, Bengaluru in the period of November 2019 to June 2021. Medial and Lateral Tibial Plateau Slope, Medial Tibial Plateau Depth, Notch Width Index were recorded along with other data such as age, gender, etiology, Lachman test, presence or absence of tears, shape of notch and other relevant data.

Influence of tibial plateau morphometric risk factors on ACL injury: A retrospective case control study

Background: ACL injuries lead to significant disability among the injured, often requiring surgical reconstruction. Anatomical morphometric analysis helps us identify individuals who are more susceptible to incurring an ACL injury, despite activity modifications, thereby improving quality of life and decreasing the economic burden posed by a potential ACL injury. We explore the relation between morphometric variations in Tibial plateau measured by Medial Tibial plateau slope (MTS), lateral Tibial plateau slope (LTS), Medial Tibial plateau depth (MTD), Tibial eminence height (TEH), Tibial eminence width (TEW) on MRI in association with an ACL tear. Methods: We retrospectively evaluated 269 patients who underwent knee MRI and clinical examination for suspected ACL pathology. Participants were divided into two groups – cases (ACL-injured) and controls (ACL-uninjured) based on MRI and clinical findings suggestive of a complete ACL tear. In both groups, MTS, LTS, MTD, TEH, TEW were calculated. Results: Patients with steeper MTS and LTS and shallower MTD had increased chances of sustaining an ACL injury (p&lt;0.05). Variations in the Tibial eminence morphometrics, however, didn't show any significant association towards increased chances of an ACL injury. Apart from MTD (p&lt;0.05), gender variations in Tibial morphometrics leading to ACL injury were insignificant.

The geometric features of tibiofemoral joint associated with anterior cruciate ligament injury: Reliability of measurements on conventional MRI

PurposeTo evaluate the measurement reliability of the geometric features of tibiofemoral joint on conventional knee MRI and also identify the features associated with increased risk of ACL injury. MethodsThis retrospective case-control study included knee MRIs of 60 patients with ACL injury (34 men, 26 women; mean age 34 ± 13.6 SD) and 60 normal individuals (31 men, 29 women; mean age 36 ± 11.4 SD). Geometric features of distal femur (intercondylar notch width, transcondylar width, and intercondylar notch angle) and tibial plateau (medial tibial plateau slope, lateral tibial plateau slope, and medial tibial plateau depth) were independently measured by two radiologists for each of the patients. Intraclass correlation coefficient (ICC) values were calculated to assess the reliability of the measurements. Variables with acceptable ICC values were included in the final logistic regression model, but the remaining were only reported descriptively. ResultsThere was good to excellent agreement between the radiologist in the measurement of ICNW and TCW. However, the agreement between the radiologists was not acceptable for the rest of the variables. The univariate logistic regression model showed as ICNW decreases, the risk of ACL injury increases (OR = 0.12, 95% CI [0.02, 0.60], p = 0.01). ConclusionsOur results suggest that ICNW and TCW are the only geometric features of the tibiofemoral joint that can be reliably measured on conventional knee MRI. Moreover, decreased ICNW is associated with an increased risk of ACL injury.

Steep posterior slope of the medial tibial plateau is associated with ramp lesions of the medial meniscus and a concomitant anterior cruciate ligament injury

BackgroundMedial meniscus (MM) tears are associated with both acute and chronic anterior cruciate ligament (ACL) insufficiency and can lead to degenerative changes in the knee. ACL reconstruction (ACLR) combined with the meniscal repair was reported to result in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term. However, a subtle tear of the MM posterior segment, also known as a ramp lesion, is difficult to detect on conventional magnetic resonance imaging (MRI) and is frequently missed in ACL-deficient knees. However, there are few studies about the associations between bone geometry and ramp lesion of the MM. This study aimed to compare sagittal medial tibial slope (MTS), medial tibial plateau depth (MTPD), and coronal tibial slope (CTS) between ACL-injured knees with and without ramp lesion of the MM. We hypothesised that patients with ramp lesion of the MM and a concomitant ACL injury have a steeper MTS and shallower MTPD than those without ramp lesion of the MM. MethodsTwenty-seven patients who underwent ACLR (group A), and 15 patients with combined MM repair (group AM) were included in the study. Anterior tibial translation (ATT) was measured under general anaesthesia just before surgery using a knee arthrometer. MRI was performed in the 10°-knee-flexed position. The MTS and MTPD were measured on sagittal view, and the CTS was measured on coronal view. These parameters were compared between the groups. Differences in MRI measurements or patient demographics between the groups were evaluated using the Mann-Whitney U test. ResultsNo significant difference was observed in demographic data and post-operative side-to-side difference in ATT between both groups. Pre-operative ATT was significantly higher in group AM than in group A (P < 0.05), whereas post-operative ATT was similar in both groups. Further, Pre-operative ATT was significantly higher in patients with MTS ≥5.0° than in those with MTS <5.0° (P < 0.05). In groups A and AM, the MTS were 3.6° ± 1.8° and 6.2° ± 2.9°, the MTPD were 2.0 ± 0.5 mm and 2.1 ± 0.6 mm, and the CTS were 2.5° ± 1.8° and 2.4° ± 1.6°, respectively. Patients in group AM had a significantly steeper MTS compared to those in group A (P < 0.01), whereas MTPD and CTS were nearly the same in both groups. When the MTS cut-off value was set at 5.0°, the sensitivity and specificity for ACL injury with concomitant ramp lesion of the MM were 0.73 and 0.76, respectively. ConclusionA steep posterior slope of the medial tibial plateau is a risk factor for ramp lesion of the MM associated with an ACL injury. Especially in patients with MTS ≥5.0°, an occult MM ramp lesion should be strongly suspected, and surgeons should prepare for MM repair in combination with ACLR.

Anatomic characteristics of the knee influence the risk of suffering an isolated meniscal injury and the risk factors differ between women and men.

To analyse the relationship between multiple anatomic characteristics of the knee (tibia and femur) and isolated meniscal injury in women and men. Forty-seven patients with isolated medial meniscal injuries, 62 patients with isolated lateral meniscal injuries, and 70 control subjects were included. Medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), medial tibial plateau depth (MTD), coronal tibial slope (CTS), femoral notch width (NW), femoral condylar width (FCW), intercondylar notch depth (ND), femoral notch width index (NWI), intercondylar notch shape index (NSI), and cruciate ligaments tensity (CLT) were measured from magnetic resonance images. Anatomic characteristics differing between groups were compared, and risk factors for isolated meniscal injury were identified by multivariate forward stepwise logistic regression for men and women separately. Risk factors for an isolated medial meniscal injury were a steeper MTS and a lowered MTD in men, and a steeper MTS and an increased NWI in women. Risk factors for isolated lateral meniscal injury were a steeper LTS and an increased NW in men, and a steeper LTS and a lowered ND in women. Risk factors for both medial and lateral meniscal injuries were a higher CTS, an increased NWI, and a looser CLT in men, and a higher CTS, an increased NSI, and a looser CLT in women. The anatomic characteristics of the tibial plateau, femur, and cruciate ligaments influence the risk of suffering isolated meniscal injury, and the risk factors differ between men and women. This study provides a reference for developing identification criteria for those at risk of isolated meniscal injury. III.

Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears.

Bone morphological factors are important for menisci. Their association with medial meniscus posterior root tears, however, has not yet been studied. This study aimed to compare sagittal medial tibial slope and medial tibial plateau depth between knees with and without medial meniscus posterior root tears. Nine healthy volunteers, 24 patients who underwent anterior cruciate ligament reconstruction, and 36 patients who underwent medial meniscus posterior root pullout repair were included. Magnetic resonance imaging examinations were performed in the 10°-knee-flexed position. The medial tibial slope and medial tibial plateau depth were compared among the groups. In healthy volunteers, the anterior cruciate ligament reconstruction group, and the medial meniscus posterior root tear group, the medial tibial slopes were 3.5° ± 1.4°, 4.0° ± 1.9°, and 7.2° ± 1.9°, respectively, and the medial tibial plateau depths were 2.1 ± 0.7mm, 2.2 ± 0.6mm, and 1.2 ± 0.5mm, respectively. Patients with medial meniscus posterior root tears had a significantly steep medial tibial slope and shallow medial tibial plateau concavity compared to those of healthy volunteers (P < 0.01) and the anterior cruciate ligament group (P < 0.01). In the multivariate logistic regression analysis, body mass index, medial tibial slope, and medial tibial plateau depth were significantly associated with medial meniscus posterior root tears. A steep posterior slope and a shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tear. Level III: Case-control study.

MRI Correlation of Anterior Cruciate Ligament Injuries with Femoral Intercondylar Notch, Posterior Tibial Slopes and Medial Tibial Plateau Depth in the Indian Population

MRI Correlation of Anterior Cruciate Ligament Injuries with Femoral Intercondylar Notch, Posterior Tibial Slopes and Medial Tibial Plateau Depth in the Indian Population

Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies

ObjectiveThe aim of this study was to determine the most important anatomical risk factors for injury of the anterior cruciate ligament (ACL) of the knee. Materials and methodsAfter study approval by our institutional ethics committee, 3 radiologists reinterpreted the preoperative magnetic resonance (MR) images of 86 patients who had undergone surgery for ACL rupture. The measurements were compared with those for a control group comprising 109 patients with intact ACL who had undergone MR examinations for other reasons, such as meniscal injuries or Baker cyst ruptures. Interobserver differences were calculated after measurement of the notch width (NW), NW index (NWI), medial condyle width (MCW), lateral condyle width (LCW), MCW/LCW ratios, alpha (α) angle, NW angle, quadriceps angle (Q angle), posterior medial tibial slope (MTS), posterior lateral tibial slope, coronal tibial slope, and depth of medial tibial plateau for each group. The relationships between these parameters and ACL injury were studied by performing logistic regression and receiver operating characteristic curve analyses in comparison with those in the control group. ResultsWe found that there were significant differences in the anatomical parameters of the NW, MCW, NWI, α angle, and MTS between the ACL injured and noninjured groups (p<0.05). There were also significant differences in the bicondylar width, α angle, Q angle, and MTS between the patients with ACL rupture because of noncontact injuries and the control group (p<0.05). The NWI and MTS had the highest predicted relative risk for both the male and female groups. ConclusionWe found that the NW, NWI, and MTS were the most important parameters in risk assessment of ACL injuries.

Knee Morphology After Secondary Ipsilateral ACL Injury Compared to Those that Have Not Reinjured

Modifiable and non-modifiable risk factors have been identified for primary anterior cruciate ligament (ACL) injury, however less research is available examining risk factors for a second ACL rupture. Identifying whether bony morphological factors are different (or more exaggerated) among those that experience a secondary ACL injury is critical to understanding if non-modifiable risk factors are associated with re-injury. PURPOSE: To identify if bony morphology is different among those that experience a secondary ACL re-injury as compared to ACL individuals that do not. METHODS: ACL participants were tracked after return-to-play following primary reconstruction, and if individuals experienced a second ipsilateral injury (ACLx2, n=14, 8f/6m,17.9±4.0yrs), the primary clinical magnetic resonance imaging was analyzed for bony morphological risk factors. ACLx2 participants were matched to individuals (sex, age, height, graft, gender and activity level) that had undergone reconstruction but did not experience re-injury (ACLx1, n=14, 8f/6m, 18.7±4.0yrs). 10 healthy controls were also enrolled (5m/5f, 20.8±3.9yrs) for the purposes of comparing our ACL data against healthy knees. Lateral and medial posterior tibial slopes (LPTS, MPTS), notch shape index (NSI), and medial tibial plateau depth of concavity (MDC) were compared between all ACL participants (combined ACLx1 and ACLx2 groups) and controls using independent t-tests and across groups (ACLx1, ACLx2, controls) using one-way ANOVAs. RESULTS: All ACL reconstructed patients had a steeper LPTS than controls (6.5±2.7deg vs. 3.9±3.7deg, d=0.87, 95% CI 0.11-1.60, P=0.023), however no difference in LPTS was found between ACLx1 and ACLx2 (6.8±3.2deg vs. 6.3±2.4deg, P>0.05). No differences in MPTS, NSI and MDC were found between all ACL participants (combined ACLx2 and ACLx1) and controls, or between ACLx1 and ACLx2 (P>0.05). CONCLUSION: Compared to healthy individuals, a steeper LPTS is a common bony abnormality among all ACL injured participants. Individuals that go onto experience a second ipsilateral ACL injury, do not have more exaggerated bony morphology than those that do not, suggesting that differences in modifiable risk factors at return-to-play may contribute to re-injury.

Examination of Knee Morphology After Secondary Ipsilateral ACL Injury Compared With Those That Have Not Been Reinjured: A Preliminary Study

Modifiable and nonmodifiable risk factors have been identified for sustaining a primary anterior cruciate ligament (ACL) injury; however, less research is available examining risk factors for a second injury. Identifying whether bony morphological factors are different (or more exaggerated) among those that experience a secondary ACL injury is critical to understanding if nonmodifiable risk factors are associated with a second injury. To determine if bony morphology is different among those that experience a secondary ACL reinjury as compared with those that do not. Case-control. University laboratory. ACL participants were tracked after return to play following primary reconstruction, and if individuals experienced a second ipsilateral injury (ACLx2; n = 14, 8f/6m, 17.9 ± 4.0y), the primary clinical MRI was analyzed for bony morphological risk factors. ACLx2 participants were matched to individuals (sex, age, height, graft, gender, and activity level) that had undergone reconstruction but did not experience reinjury (ACLx1, n = 14, 8f/6m, 18.7 ± 4.0y). Ten controls were also enrolled (5m/5f, 20.8 ± 3.9y) for the purposes of comparing the authors' ACL data against healthy knees. Lateral and medial posterior tibial slopes (LPTS, MPTS), notch shape index (NSI), and medial tibial plateau depth of concavity (MDC). All ACL-reconstructed patients (combined ACLx1 and ACLx2 group) had a steeper LPTS than controls (d = 0.87, 95% CI 0.11-1.60, P = .023); however, no difference in LPTS was found between ACLx1 and ACLx2 (P > .05). No differences in MPTS, NSI, and MDC were found between all ACL participants (combined ACLx2 and ACLx1) and controls or between ACLx1 and ACLx2 (P > .05). Compared to healthy individuals, a steeper LPTS is a common bony abnormality in all ACL-injured participants. Individuals that go on to experience a second ipsilateral ACL injury do not have more exaggerated bony morphology than those that do not suggesting that differences in modifiable risk factors at return to play may contribute to reinjury.

Tibial plateau slopes in Indian patients with or without anterior cruciate ligament injury: a magnetic resonance imaging study.

To compare anterior cruciate ligament (ACL)-injured and ACL-intact patients as well as males and females in terms of tibial plateau slopes to determine their association with ACL injury. Magnetic resonance images (MRI) of the knee of 310 male and 179 female skeletally mature Indian patients (mean age, 40 years) with (n=170+29) or without (n=140+150) ACL injury were reviewed. Their medial and lateral tibial plateau slopes (MTPS and LTPS), medial tibial plateau depth (MTPD), and lateral tibial plateau height (LTPH) were measured using MRI. The ACL-injured and ACL-intact groups were comparable in terms of MTPS (6.72º vs. 6.73º, p=0.07), LTPS (5.68º vs. 5.70º, p=0.09), MTD (1.74 vs. 1.73 mm, p=0.356), and LTH (2.21 vs. 2.22 mm, p=0.393). Males and females were also comparable in terms of MTPS and LTPS in both ACL-injured and ACL-intact groups. ACL-injured and ACL-intact patients as well as males and females were comparable in terms of the tibial plateau slope parameters.

New combined method using MRI for the assessment of tibial plateau slope and depth as risk factors for anterior cruciate ligament injury in correlation with anterior cruciate ligament arthroscopic findings: does it correlate?

Background Anterior cruciate ligament (ACL) injury continues to be the largest single problem in orthopaedic sports medicine. MRI has become the prime diagnostic tool for various pathological and anatomical variability conditions of the knee. Objectives The aim of this study was to test the integrity of the new combined method for the assessment of tibial plateau anatomic variables using conventional MRI. Settings and design This was a retrospective control study. Patients and methods Medial tibial plateau slope (MTPS), lateral tibial plateau slope (LTPS) and medial tibial plateau depth (MTPD) were evaluated in the ACL-injured group of patients ( n = 52) and the non-ACL-injured control group ( n = 33) using MRI scan. Inclusion criteria for the ACL-injured group, as surgically confirmed, were isolated ACL injury. However, inclusion criteria for the non-ACL-injured group were minor trauma, bruises, etc. Statistical analysis Statistical analysis was carried out using Student's t -test and intraclass correlation coefficient. A P value less than 0.05 was assigned as significant. Results Both male and female patients in the ACL-injured group showed increased LTPS in comparison with the control group ( P = 0.0197), with no significant difference in MTPS and MTPD ( P = 0.73 and 0.8, respectively). Steeper LTPS was detected in the male population of the patient group than in the control group ( P = 0.0001). Male participants from the control group had less steep MTPS ( P = 0.002) and LTPS ( P = 0.034) and deeper MTPD ( P = 0.004) compared with female participants of the control group. Conclusion We conclude that the combined method by Khan and colleagues using conventional MRI for the measurement of MTPS, LTPS and MTPD as risk factors for ACL injury is solid and reproducible. Level of evidence Diagnostic study level III.

Bony morphology of the knee and non-traumatic meniscal tears: is there a role for meniscal impingement?

Meniscal tears are an important cause of morbidity. The aim of this study was to examine the relationship between non-traumatic meniscal tears and the intrinsic bony morphology of the knee. A retrospective analysis of 160 knee MRI scans in 150 patients was carried out who met the following criteria: (a) age between 20 and 45 years, (b) no history of knee trauma, surgery, infection, metabolic bone disease, and (c) no collateral or cruciate ligamentous injury. The medial tibial slope (MTS), lateral tibial slope (LTS), medial tibial plateau depth (MTPD), and medial and lateral femoral condylar offset ratios were calculated. The anterior horn, body, and posterior horn of the menisci were graded as 0 (no tear), 1 and 2 (degenerative changes), or 3 (definitive tear). One-way ANOVA and linear regression was used for statistical analysis. In patients with grade 3 tears of the posterior horn of the medial meniscus, there was a significant association with shallower MTS (p < 0.05), smaller medial femoral offset ratio (p < 0.05) and smaller lateral femoral offset ratio (p < 0.05). Patients with grade 3 tears of anterior horn of the lateral meniscus had a significant association with shallower LTS (p < 0.05). No significant association was seen between MTPD and meniscal tears. Our results suggest an association between bony morphology of the knee and non-traumatic meniscal tears. Shallower MTS and LTS may result in impingement of posterior horn of medial meniscus and anterior horn of lateral meniscus, respectively. Future kinematic studies will be needed to help confirm our findings.

Tibial Plateau Geometry Influences Lower Extremity Biomechanics During Landing

Background: Intersubject differences in lateral and medial posterior tibial plateau slope, coronal tibial slope (CTS), and medial tibial plateau depth (MTD) may influence one’s susceptibility for anterior cruciate ligament (ACL) injury. Understanding how these structural characteristics influence hip and knee joint biomechanics during weightbearing activity may advance our understanding of how tibial plateau geometry influences one’s injury risk potential. Purpose/Hypotheses: To determine the extent to which tibial plateau geometry is associated with frontal and transverse plane hip and knee joint biomechanics during the initial landing phase of a double-legged drop landing. Greater lateral tibial slope combined with lower medial/lateral tibial slope ratio would predict greater tibial internal rotation motion and moments. Lower CTS would predict greater hip adduction and knee valgus motion and reduced internal peak varus moments. These associations would be stronger when combined with a shallower MTD. Study Design: Descriptive laboratory study. Methods: Magnetic resonance scans of the knee were obtained on 23 female participants who were also assessed for hip and knee joint biomechanics during the initial landing phase of double-legged drop jumps. Results: Once controlling for the respective initial hip flexion or initial knee flexion angle at ground contact, lower CTS consistently predicted greater initial and peak hip adduction and knee valgus angles (R2 range, .212-.427, P < .027). Greater coronal and lateral tibial slope predicted greater hip internal rotation (femur relative to pelvis) at initial contact (R2 = .504) and greater CTS and lower medial/lateral tibial slope ratio predicted greater knee internal rotation (tibia relative to femur) excursions (R2 = .594, P = .001). Joint geometry was not associated with hip or knee peak joint moments. Conclusion: These data confirm substantial intersubject differences in tibial condylar geometry that are associated with intersubject differences in hip and knee motion patterns when landing from a jump. Clinical Relevance: The current findings may partially explain a female’s greater likelihood of demonstrating combined motion patterns of knee valgus and external rotation during landing. Although tibial geometry cannot be modified through training, these associations suggest that tibial geometry may have a substantial influence on tibiofemoral joint biomechanics when the knee is subjected to external loads and deserves further study in our understanding of ACL injury.

The ACL Dilemma

The ACL Dilemma