Medial Tibial Plateau Slope Research Articles

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.

Anchor-Based Meniscal Ramp Repair

Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.

Measurement of Posterior Tibial Slope in Healthy Indian Population: A CT-Based Study.

Recreation of near normal posterior tibial slope is required for proper knee biomechanics after unicondylar as well as total knee arthroplasties. It is also required for proper functioning of anterior cruciate ligament after high tibial osteotomies. Researchers have found differences in values of posterior tibial slopes in individuals of different ethnicities. So far there is no study measuring the posterior slopes of medial and lateral tibial plateau separately in knees of healthy Indian population via three dimensional imaging modalities like computed tomography. The aim of our study is to find out the slopes of medial and lateral tibial plateau separately through computed tomography (CT) scans. CT-based measurements of posterior tibial slopes were done in 62 healthy knees. There were 55 males and 7 females. Age groups were in the range of 17-45years. Mean values of Posterior tibial slope of medial and lateral tibial plateau for combined sample were 8.60° ± 3.51° and 7.94° ± 3.91°. Mean values of medial and lateral tibial plateau for males were 8.33° ± 3.51° and 7.71° ± 4.07° respectively; while for females were 10.69° ± 2.86° and 9.77° ± 1.32°, respectively.In our study, there was a large range of slopes, extending from + 0.6° to 15.6° for medial tibial slope, from 0° to 15° for lateral tibial slope. The minimum values of Medial tibial plateau slope are very low as compared to the previous study done in Asian population. Further CT based studies are required to measure values of posterior tibial slope for larger sample from Indian population. The implant design suitable and their implantation guidelines for western population may not be appropriate for Indian population.

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<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<0.05), gender variations in Tibial morphometrics leading to ACL injury were insignificant.

An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review.

The posterior tibial slope (PTS) is considered a risk factor for anterior cruciate ligament (ACL) injury. However, the influence of PTS on graft failure following ACL reconstruction remains relatively unknown. Therefore, this systematic review was conducted to investigate whether PTS could be a potential risk factor for graft failure after ACL reconstruction. PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, and Wanfang Database were comprehensively searched from inception to March 31, 2021. Observational studies reporting the associations of medial tibial plateau slope (MTPS) or lateral tibial plateau slope (LTPS) with graft failure after ACL reconstruction were evaluated. Twenty studies involving 12 case-control studies, 4 retrospective studies and 4 cross-sectional studies including 5326 patients met the final inclusion criteria. The high heterogeneity and the characteristics of nonrandomized controlled trials limited data synthesis. Fifteen of the 20 included studies detected a significant association between increased PTS and ACL graft failure, while 5 studies concluded that increased PTS was not associated with ACL graft failure. Ten studies suggested that MTPS is associated with ACL graft failure, and six studies suggested that LTPS is associated with ACL graft failure. The mean MTPS values for nonfailure group ranged from 3.5° ± 2.5° to 14.4° ± 2.8°. For the graft failure group, MTPS ranged from 4.71° ± 2.41° to 17.2° ± 2.2°. The mean LTPS values for nonfailure group ranged from 2.9° ± 2.1° to 11.9° ± 3.0°. For the graft failure group, LTPS ranged from 5.5° ± 3.0° to 13.3° ± 3.0°. The reported PTS values that caused ACL graft failure was greater than 7.4° to 17°. Based on the current clinical evidence, increased PTS is associated with a higher risk of ACL graft failure after ACL reconstruction. Despite various methods of measuring PTS have high reliability, there is still vast disagreement in the actual value of PTS. IV.

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.

Reliability of Plain Radiographs Versus Magnetic Resonance Imaging to Measure Tibial Slope in Sports Medicine Patients: Can They Be Used Interchangeably?

Background:The slope of the tibial plateau has been proposed as a reason for failure of anterior cruciate ligament reconstruction.Purpose:To evaluate the interobserver reliability of measurements of tibial slope on radiographs versus magnetic resonance imaging (MRI) scans and to assess whether the modalities can be used interchangeably for this purpose.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:This retrospective study included 81 patients aged 18 to 30 years who were evaluated in a sports medicine setting for knee pain and who had lateral knee radiographs as well as knee MRI scans on file. Medial and lateral tibial plateau slope measurements were made by 3 blinded reviewers from the radiographs and MRI scans using graphic overlay software. The paired t test was used to compare measurements of the medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) from radiographs and MRI scans. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver reliability of measurements within each imaging modality, and Pearson correlation coefficients were calculated to determine the relationship between measurements on radiographs versus MRI scans.Results:Imaging from 81 patients were included. The average MTPS was significantly larger on radiographs compared with MRI scans (8.7° ± 3.6° vs 3.7° ± 3.4°; P < .001), and the average LTPS was also significantly larger on radiographs compared with MRI scans (7.9° ± 3.4° vs 5.7° ± 3.7°; P < .001). ICC values indicated good to excellent intraobserver agreement for all imaging modalities (ICC, 0.81-0.97; P ≤ .009). The ICCs for interobserver reliability of MTPS and LTPS measurements were 0.92 and 0.85 for radiographs, 0.87 and 0.83 for MRI based off the subchondral bone, and 0.86 and 0.71 for MRI based off the cartilage, respectively (P < .001). Medium correlation was noted between radiographic and MRI measurements; Pearson correlation coefficients for radiographic versus subchondral MRI measurements were 0.30 and 0.37 for MTPS and LTPS, respectively.Conclusion:The average MTPS and LTPS were significantly larger on radiographs compared with MRI scans. Although tibial slope measurements using radiography and those using MRI are reliable between individuals, the measurements from radiographs and MRI scans cannot be used interchangeably, and caution should be used when interpreting and comparing studies using measurements of the tibial slope.

Normal anatomical variations of tibial plateau geometry in Indian population: a magnetic resonance image-based study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Geometry of tibial plateau characterized by its medial tibial plateau slope (MTS), lateral tibial plateau slope (LTS), depth of concavity of medial tibial plateau (CMT), convexity of lateral tibial plateau on sagittal section and coronal tibial plateau slope (CTS) on coronal section of tibia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 500 subjects (male-250, female-250) were included in the study. Various tibial slopes of each subject were measured using magnetic resonance image (MRI) of knee joint. Data was analysed using appropriate statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; When considering male and female one group (total population) mean (±SD) of MTS, LTS, CMT, CTS were 7.73±3.20&lt;sup&gt;0&lt;/sup&gt;, 4.68±2.75&lt;sup&gt;0&lt;/sup&gt;, 2.56±0.56 mm and 2.61±2.15&lt;sup&gt;0&lt;/sup&gt; respectively. In male population mean (±SD) of MTS, LTS, CMT, CTS were 6.94±3.2&lt;sup&gt;0&lt;/sup&gt;, 3.77±1.85&lt;sup&gt;0&lt;/sup&gt;, 2.7±0.55 mm, 3.06±2.39&lt;sup&gt;0 &lt;/sup&gt;respectively. In female population population mean (±SD) of MTS, LTS, CMT, CTS were 9.28±2.65&lt;sup&gt;0&lt;/sup&gt;, 6.45±3.36&lt;sup&gt;0&lt;/sup&gt;, 2.28±0.48 mm, 1.75±1.24&lt;sup&gt;0&lt;/sup&gt; respectively. Over all MTS and LTS was poorly correlated (r=0.43). Female had significant steeper MTS (p=0.013) and LTS (p=0.001) but had less CTS (p=0.04) and shallow CMT (p=0.012) compared to male.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Knowledge of this study could be used in different operative orthopaedic procedures (like knee arthroplasty, high tibial osteotomy, tibial plateau fracture fixation), non-contact ACL injury risk assessment.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Importance of Posterior Tibial Slope, Medial Tibial Plateau Slope and Lateral Tibial Plateau Slope in Anterior Cruciate Ligament Injury

Increased posterior tibial slope (PTS), medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) have been proposed as potential risk factors for anterior cruciate ligament (ACL) tear. However, prior literature is inconclusive. The primary goal of the study was to investigate the relationship of MTPS, LTPS and PTS with ACL tears. The secondary goal was to determine whether injury mechanisms, age, gender, tobacco, obesity, extreme PTS (>12°) or previous injuries are risk factors in ACL tears. Three groups were identified: a study group of patients with ACL injury; a second group diagnosed with meniscal injury; and a third group of non-injured patients. Demographic data was collected. MTPS and LTPS were measured in MRI and PTS in lateral radiographs by two blinded observers. Data was analyzed using SPSS. 416 patients were included in the study. MTPS ranged from 0° to 14° (average value 5.66 ± 2.98), LTSA 0° to 16° (5.69 ± 3.5) and PTS 0° to 17° (6.75 ± 3.18). Neither MTPS, LTPS nor PTS revealed increased risk of ACL tears related with higher slopes, although high MTPS showed a decreased risk. However, when comparing traumatic groups, extreme PTS was associated with LCA tear, but no differences were found when comparing non-traumatic groups. This could mean that the importance of extreme angles in the LCA rupture may be restricted to traumatic mechanisms. Previous ACL tear was identified as a risk factor to ACL tear; increased age and a traumatic mechanism were associated with a lower risk.

Study of relationship of posterior tibial slope in anterior cruciate ligament injury

ObjectiveTo determine the relationship between Posterior Tibial slope in terms of medial and lateral in Anterior cruciate ligament deficient patients. MethodsMagnetic resonance images (MRI) of the knee of 100 ACL injured patients and 100 ACL intact patients were studied. Their medial and lateral posterior tibial slopes were measured using MRI. Of 200 subjects, 100 (Male- 63, Female- 37) were controls, other 100 (Male – 68, Female-32) were ACL injured cases. Using DIACOM viewer software,the slopes of both medial and lateral slopes were measured. Range of Variation, mean value and standard deviation of medial tibial plateau slope (MTS), lateral tibia plateau slope (LTS) of controls and ACL injured patients were measured. The data collected were entered into Microsoft excel worksheet and analysed using statistical package for social sciences, Version 15.0 (SPSS Inc. Chicago, IL, USA). Distribution of data was confirmed using Shapiro's Wilk Test and appropriate parametric statistics were applied. For all analysis p value < 0.05 was set to be significant. ResultsIn control (ACL uninjured) population mean MTS was 5.95° with SD 3.09°, mean LTS was 6.08° with SD 3.48°. In ACL injured population mean MTS 6.41° with SD 2.66°, mean LTS was 8.12° with SD 3.65°. So ACL injured population had MTS steeper than control population with no statistical significance (p value < 0.27) and LTS was steeper than control population with statistical significance (p value < 0.001),where as there were comparable results between male and females. ConclusionOur current results indicate that lateral PTS is a risk factor for patients with primary ACL tears as compared with ligament-intact controls. Therefore,PTS should be considered as independent modifiable risk factors in ACL injury.

Steep Posterior Tibial Slope, Anterior Tibial Subluxation, Deep Posterior Lateral Femoral Condyle, and Meniscal Deficiency Are Common Findings in Multiple Anterior Cruciate Ligament Failures: An MRI Case-Control Study

Background: Tibiofemoral anatomic parameters, such as tibial slope, femoral condyle shape, and anterior tibial subluxation, have been suggested to increase the risk of anterior cruciate ligament (ACL) reconstruction failure. However, such features have never been assessed among patients experiencing multiple failures of ACL reconstruction. Purpose: To compare the knee anatomic features of patients experiencing a single failure of ACL reconstruction with those experiencing multiple failures or with intact ACL reconstruction. Study: Case-control study; Level of evidence, 3. Methods: Twenty-six patients who experienced failure of revision ACL reconstruction were included in the multiple-failure group. These patients were matched to a group of 25 patients with failure of primary ACL reconstruction and to a control group of 40 patients who underwent primary ACL reconstruction with no failure at a minimum follow-up of 24 months. On magnetic resonance imaging (MRI), the following parameters were evaluated: ratio between the height and depth of the lateral and medial femoral condyles, the lateral and medial tibial plateau slopes, and anterior subluxation of the lateral and medial tibial plateaus with respect to the femoral condyle. The presence of a meniscal lesion during each procedure was evaluated as well. Anatomic, demographic, and surgical characteristics were compared among the 3 groups. Results: The patients in the multiple-failure group had significantly higher values of lateral tibial plateau slope (P < .001), medial tibial plateau slope (P < .001), lateral tibial plateau subluxation (P < .001), medial tibial plateau subluxation (P < .001), and lateral femoral condyle height/depth ratio (P = .038) as compared with the control group and the failed ACL reconstruction group. Moreover, a significant direct correlation was found between posterior tibial slope and anterior tibial subluxation for the lateral (r = 0.325, P = .017) and medial (r = 0.421, P < .001) compartments. An increased anterior tibial subluxation of 2 to 3 mm was present in patients with a meniscal defect at the time of the MRI as compared with patients who had an intact meniscus for both the lateral and the medial compartments. Conclusion: A steep posterior tibial slope and an increased depth of the lateral femoral condyle represent a common finding among patients who experience multiple ACL failures. Moreover, higher values of anterior subluxation were found among patients with repeated failure and those with a medial or lateral meniscal defect.

Association Between Tibial Plateau Slopes and Anterior Cruciate Ligament Injury: A Meta-analysis

To investigate the associations of medial tibial plateau slope (MTPS), lateral tibial plateau slope (LTPS), and coronal tibial plateau slope (CTPS) with anterior cruciate ligament (ACL) injury both in the general population and in different gender subgroups. PubMed, Ovid, Embase, and Scopus databases were searched through from inception to August 31, 2016. Observational studies reporting associations of MTPS/LTPS/CTPS with ACL injury were retrieved for analysis. Either a fixed- or random-effects model was used to calculate the overall standardized mean difference (SMD). Reviews, meeting abstracts, cadaver or animal studies, and other studies without disclosing full text were excluded in this study. A total of 29 studies were included. Subjects with ACL injury exhibited a significant increase in MTPS (SMD: 0.34 [95% confidence interval (CI): 0.18, 0.49]; P < .0001) and LTPS (SMD: 0.49 [95% CI: 0.30, 0.68]; P < .00001), but not in the CTPS (SMD: 0.09 [95% CI:-0.10, 0.27]; P= .36), compared with controls. Meanwhile, significant differences in MTPS and LTPS were observed in the male subgroup (SMD: 0.41 [95% CI: 0.20, 0.62]; P= .0001 and SMD: 0.55 [95% CI: 0.26, 0.85]; P= .0002, respectively) but not in the female (SMD: 0.31 [95% CI:-0.02, 0.64]; P=.06 and SMD: 0.26 [95% CI:-0.04, 0.56]; P= .09, respectively). The present meta-analysis showed that the increases in MTPS and LTPS were overall risk factors of ACL injury. However, these slopes would only be considered as "at risk" for males, but not for females. In addition, it was also proved that CTPS was not a risk factor of ACL injury. Level III, meta-analysis of Level II and III studies.

Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau

To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P= .049) despite having lower body mass index (P= .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P= .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study.

Increased Lateral Tibial Plateau Slope Predisposes Male College Football Players to Anterior Cruciate Ligament Injury.

There are conflicting reports regarding the role of osseous morphologic characteristics such as an increased tibial slope as associated with an anterior cruciate ligament (ACL) injury. Few studies have analyzed the role of a combination of osseous morphologic characteristics in matched case control studies. The aim of this study was to determine if there is an association between osseous morphologic characteristics and ACL injury in male college American-football players. Ninety male U.S. National Collegiate Athletic Association (NCAA) Division-I college football players who underwent magnetic resonance imaging (MRI) for a knee injury between 2005 and 2014 were included. Subjects with an ACL injury (ACL-injured group) were matched for age, height, weight, and body mass index to subjects without an ACL injury (control group). Several osseous morphologic characteristics including medial and lateral condylar width, medial and lateral plateau width, notch width, bicondylar width, notch width index, and medial and lateral tibial slopes were measured and were compared between groups. Conditional logistic regression was used to analyze the data. Significance was set at p < 0.05. According to univariable analysis, a narrower lateral femoral condyle (odds ratio, 0.82 [95% confidence interval (95% CI), 0.68 to 0.97]), increased medial tibial plateau slope (odds ratio, 1.42 [95% CI, 1.09 to 1.85]), and increased lateral tibial plateau slope (odds ratio, 1.43 [95% CI, 1.15 to 1.78]) were significantly associated with ACL injury. Multivariable analysis revealed that increased lateral tibial slope (odds ratio, 1.32 [95% CI, 1.03 to 1.70]) was the sole independent predictor of ACL injury. Based on this study, osseous morphology, specifically increased lateral tibial slope, is associated with ACL injury in male college football players. These data might help to improve prevention strategies to lower ACL injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Increased Lateral Tibial Plateau Slope Predisposes Male College Football Players to ACL Injury

There are conflicting reports regarding the role of bony morphology characteristics such as an increased tibial slope as a risk factor of anterior cruciate ligament (ACL) injury. The purpose of this study was to determine if there is a correlation between bony morphology characteristics and ACL injury risk in male college football players. Ninety male college football players who underwent magnetic resonance imaging (MRI) for a knee injury between 2005 and 2014 were included. Subjects with an ACL injury (ACL injury group) were matched for age, height, weight and BMI to subjects without ACL injury (control group). Several bony morphology characteristics including medial and lateral condyle width, medial and lateral plateau width, notch width, bicondylar width, notch width index, and medial and lateral tibial slope were measured and compared between groups. Conditional logistic regression was used to analyse the data. Significance level was set at p<0.05. According to univariate analysis, a narrower lateral femoral condyle (OR, 0.82; CI, 0.68-0.97), increased medial tibial plateau slope (OR, 0.1.42; CI, 1.85) and increased lateral tibial plateau slope (OR, 1.43; CI, 1.15-1.78) were associated with an increased risk for ACL injury. Multivariate analysis revealed that increased lateral tibial slope (OR, 1.32; CI, 1.03-1.70) was the sole independent risk of ACL injury. A narrower lateral femoral condyle width and an increased medial and lateral tibial slope predispose male college football players to ACL injury. It is suggested to enroll these high-risk subjects in prevention programs to reduce the incidence of injury.

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.

Increased Slope of the Lateral Tibial Plateau Subchondral Bone Is Associated With Greater Risk of Noncontact ACL Injury in Females but Not in Males

Background: There is an emerging consensus that increased posterior-inferior directed slope of the subchondral bone portion of the tibial plateau is associated with increased risk of suffering an anterior cruciate ligament (ACL) injury; however, most of what is known about this relationship has come from unmatched case-control studies. These observations need to be confirmed in more rigorously designed investigations. Hypothesis: Increased posterior-inferior directed slope of the medial and lateral tibial plateaus are associated with increased risk of suffering a noncontact ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: In sum, 176 athletes competing in organized sports at the college and high school levels participated in the study: 88 suffering their first noncontact ACL injury and 88 matched controls. Magnetic resonance images were acquired, and geometry of the subchondral bone portion of the tibial plateau was characterized on each athlete bilaterally by measuring the medial and lateral tibial plateau slopes, coronal tibial slope, and the depth of the medial tibial plateau. Comparisons between knees of the same person were made with paired t tests, and associations with injury risk were assessed by conditional logistic regression analysis of ACL-injured and control participants. Results: Controls exhibited side-to-side symmetry of subchondral bone geometry, while the ACL-injured athletes did not, suggesting that the ACL injury may have changed the subchondral bone geometry. Therefore, the uninjured knees of the ACL-injured athletes and the corresponding limbs of their matched controls were used to assess associations with injury risk. Analyses of males and females as a combined group and females as a separate group showed a significant association between ACL injury risk and increased posterior-inferior directed slope of the lateral tibial plateau slope. This relationship was not apparent when males were analyzed as a group. Multivariate analyses indicated that these results were independent of the medial tibial plateau slope, coronal tibial slope, and depth of the medial tibial plateau, which were not associated with ACL injury. Conclusion: There is a 21.7% increased risk of noncontact ACL injury with each degree increase of the lateral tibial plateau slope among females but not among males. The medial tibial plateau slope, coronal tibial slope, and depth of the medial tibial plateau were not associated with risk of injury for females or males.

The influence of the tibial plateau slopes on injury of the anterior cruciate ligament: a meta-analysis

The purpose of this meta-analysis was (1) to examine the effect of the tibial plateau slopes (medial and lateral) on anterior cruciate ligament (ACL) injury and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls. The PubMed database was searched through to 1 November 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. A meta-analysis was conducted, and either a fixed- or a random-effects model was used to calculate the overall weighted mean difference (WMD). Twelve studies (n = 1,871: 923 patients in the ACL-injured group and 938 patients in the control group) were included. The medial tibial plateau slope in the ACL group ranged from 1.8° ± 3.7° to 12.1° ± 3.3° while it ranged from 2.9° ± 2.8° to 9.5° ± 3° among the controls. The lateral tibial plateau slope in the ACL ranged from 1.8° ± 3.2° to 11.5° ± 3.5° and 0.3° ± 3.6° to 9° ± 4° in the control group. Statistically significant increased angles were observed in ACL-injured group compared to control group for medial tibial plateau slope (WMD, 1.1°; 95 % confidence interval, 0.5°-1.7°) and lateral tibial plateau slope (WMD, 1.8°; 95 % confidence interval, 1.3°-2.3°). Sensitivity analysis and subgroup analysis proved this to be a reliable result. The current meta-analysis suggests that both, increased medial and lateral tibial plateau slopes, are associated with increased susceptibility to ACL injury regardless of gender. In addition, this study indicates a stronger evidence for lateral tibial plateau slope to be associated with ACL injury compared with medial tibial plateau slope due to the larger increased angle value and on the basis of consistency among the included studies.

In Vivo Evidence for Tibial Plateau Slope as a Risk Factor for Anterior Cruciate Ligament Injury

Background: In vivo studies reporting tibial plateau slope as a risk factor for anterior cruciate ligament (ACL) injury have been published with greatly increasing frequency. Purpose: To examine and summarize the in vivo evidence comparing tibial slope in ACL-injured and uninjured populations. Study Design: Systematic review and meta-analysis. Methods: We reviewed publications in Scopus, SPORTDiscus, CINAHL, and PubMed to identify all studies reporting a measure of tibial plateau slope between ACL-injured groups and controls. A meta-analysis was performed including calculation of effect size and 95% confidence interval as well as 95% confidence intervals for the mean values of the measurement in each study. Results: Fourteen studies met our inclusion/exclusion criteria. Five of 6 radiographic studies reporting medial tibial plateau slope (MTPS) demonstrated significant differences between controls and ACL-injured groups, while only 1 of 7 magnetic resonance imaging (MRI) studies reported significant differences between groups. Mean MTPS measurements and standard deviations reported for controls ranged from 2.9° ± 2.8° anterior to 9.5° ± 3° posterior. For ACL-injured patients, MTPS ranged from 1.8° ± 3.5° anterior to 12.1° ± 3.3° posterior. Lateral tibial plateau slope (LTPS) was reported to be significantly greater in ACL-injured groups in all 5 MRI-based studies reporting group comparisons. Mean values for LTPS in controls ranged from 0.3° ± 3.6° anterior slope to 9° ± 4° posterior slope. In ACL-injured groups, mean reported LTPS values ranged from 1.8° ± 3.2° to 11.5° ± 3.54° posterior slope. Conclusion: Despite high measures of reliability for the various methods reported in current studies, there is vast disagreement regarding the actual values of the slope that would be considered “at risk.” Reported tibial slope values for control groups vary greatly between studies. In many cases, the study-to-study differences in “normal” tibial slope exceed the difference between controls and ACL-injured patients. The clinical utility of imaging-based measurement methods for the determination of ACL injury risk requires more reliable techniques that demonstrate consistency between studies.

A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees

The role played by anatomical factors in ACL injury remains elusive. In this study, objective methods were used to characterize ACL volume, tibial slopes and notch geometry from ACL-injured and matched-control subjects. The study tested four hypotheses: (1) the medial tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, (2) the lateral tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, (3) the femoral intercondylar notch dimensions are smaller in the injured group compared to the non-injured group and (4) the ACL volume, tibial plateau slopes and intercondylar notch dimensions are all independent of each other. Fifty-four subjects were divided into two groups, those who had suffered a non-contact ACL injury and those who still had two healthy ACLs, matched to the injured subjects by gender, age, height and weight. The lateral tibial plateaus in the uninjured contralateral knees of the injured subjects had a significantly steeper posterior slope (1.8° vs. −0.3°), a factor that potentially contributed to the ACL injury in the opposite knee. The intercondylar notch dimensions were found to be smaller in the injured subjects, potentially putting the ACL at risk of impingement, and intercondylar notch volume was correlated to ACL volume ( r=0.58). Discriminant analysis showed that the notch width at the inlet was the best single predictor of ACL injury.