Slope Of Lateral Tibial Plateau Research Articles

Gender differences in the impact of anatomical factors on non-contact anterior cruciate ligament injuries: a magnetic resonance study

PurposeTo identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders.MethodsA retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation.ResultsIncreased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males.ConclusionThis study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.

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.

Effect of Anterolateral Ligament Status and Inherent Knee Anatomy on Anterior Tibial Subluxation of the Lateral Compartment After Acute Anterior Cruciate Ligament Injury: A Cohort Study Based on MRI Analysis

Background: Anterior tibial subluxation (ATS) of the lateral compartment entails a pathological tibiofemoral alignment in knees with anterior cruciate ligament (ACL) injury. Causes of increased ATS after an acute ACL injury are not clear, but soft tissue abnormalities and bony variations of the knee are potential causes. Purpose: To determine whether increased ATS of the lateral compartment in knees with acute ACL injury is associated with (1) anterolateral ligament (ALL) status and (2) inherent anatomy of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 337 patients with clinically diagnosed ACL injuries treated between September 2019 and August 2021 were retrospectively reviewed, and 119 patients with acute ACL injury were included. Of them, 79 patients with impaired ALL (ALL injury group) and 40 patients with intact ALL (ALL intact group) were identified based on magnetic resonance imaging (MRI). The ATS of the lateral compartment measured on MRI was compared between the 2 groups. The bony anatomy of knees, quantified by the LFC length, LFC height, LTP length, and LTP slope, was also evaluated on MRI and correlated with the ATS with partial correlation coefficients. Multivariate linear regression was used to identify the independent predictors of increased ATS. Results: The ATS of the lateral compartment in the ALL injury group was significantly larger than that in the ALL intact group (6.3 mm vs 4.0 mm, respectively; P = .001). In all included patients, the presence of ALL injuries independently predicted a mean increase in ATS of 1.8 mm (P = .003). In the ALL injury group, ATS was significantly correlated with LFC length (r = 0.463; P < .001), LFC height (r = −0.415; P < .001), and LTP slope (r = 0.453; P < .001); further, a 1-mm increase in LFC length, 1-mm decrease in LFC height, and 1° increase in LTP slope independently predicted a mean increase in ATS of 0.7 mm (P < .001), 0.6 mm (P < .001), and 0.5 mm (P < .001), respectively. In the ALL intact group, there was no significant correlation between ATS and any bony parameter. Conclusion: An impaired ALL increased the ATS of the lateral compartment after acute ACL injuries. In patients with combined ALL injuries, a flatter LFC and a steeper LTP in the sagittal plane were predictors of a further increase in ATS.

Influence of Bone Morphology on In Vivo Tibio-Femoral Kinematics in Healthy Knees during Gait Activities.

An improved understanding of the relationships between bone morphology and in vivo tibio-femoral kinematics potentially enhances functional outcomes in patients with knee disorders. The aim of this study was to quantify the influence of femoral and tibial bony morphology on tibio-femoral kinematics throughout complete gait cycles in healthy subjects. Twenty-six volunteers underwent clinical examination, radiographic assessment, and dynamic video-fluoroscopy during level walking, downhill walking, and stair descent. Femoral computer-tomography (CT) measurements included medial condylar (MC) and lateral condylar (LC) width, MC and LC flexion circle, and lateral femoral condyle index (LFCI). Tibial CT measurements included both medial (MTP) and lateral tibial plateau (LTP) slopes, depths, lengths, and widths. The influence of bony morphology on tibial internal/external rotation and anteroposterior (AP)-translation of the lateral and medial compartments were analyzed in a multiple regression model. An increase in tibial internal/external rotation could be demonstrated with decreasing MC width β: −0.30 (95% CI: −0.58 to −0.03) (p = 0.03) during the loaded stance phase of level walking. An increased lateral AP-translation occurred with both a smaller LC flexion circle β: −0.16 (95% CI: −0.28 to −0.05) (p = 0.007) and a deeper MTP β: 0.90 (95% CI: 0.23 to 1.56) (p = 0.01) during the loaded stance phase of level walking. The identified relationship between in vivo tibio-femoral kinematics and bone morphology supports a customized approach and individual assessment of these factors in patients with knee disorders and potentially enhances functional outcomes in anterior cruciate ligament injuries and total knee arthroplasty.

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.

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.

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.

Identification of Radiographic Parameters Associated with Anterior Cruciate Ligament Injury

It is well established that limb alignment parameters such as increased knee valgus can be a risk factor for anterior cruciate ligament (ACL) injuries, and may play a role in failure after repair or reconstruction. Previous work has examined the association of some radiographic parameters from the patellar instability literature, which shares some of the same anatomic risk factors as ACL injuries. These have found mixed results regarding the predictive utility of these and related radiographic parameters when applied to ACL injuries, albeit with small sample sizes. The purpose of this study is to examine multiple radiographic parameters from the patellar instability literature in a large sample of ACL tears and compare these with a large cohort of age-matched controls. We hypothesized that alignment parameters reflective of knee valgus and rotational imbalance would be significantly higher in the ACL tear cohort. We also hypothesized that significant difference in these parameters would be observed in patients with meniscal injuries in addition to ACL tears. Consecutive cases of magnetic resonance imaging (MRI)-documented ACL ruptures were identified, along with an age-matched cohort of prospective controls with knee MRIs demonstrating intact ACLs and no meniscal pathology. Records of prospective controls were screened for a history of patellar instability, patellar maltracking, and/or patellofemoral pain syndrome. The presence of one or more of these diagnoses resulted in exclusion from the control group. All MRIs were reviewed by fellowship-trained musculoskeletal radiologist with more than 10 years of experience and familiarity with the radiographic parameters of interest. Seventeen parameters were measured on each MRI. Differences in central tendency between the ACL tear and control group were compared with Student’s t-test for normally distributed data or the Wilcoxon-Mann-Whitney test for nonparametric data, as determined by the Shapiro-Wilk test. Differences between controls and ACL tears with and without meniscal tears were assessed with the Kruskal-Wallis test, followed by Dunn’s post-hoc analysis when significant. The relationship between continuous and categorical variables was explored with logistic regression. Multivariable logistic regression analysis was conducted to determine which parameters, if any, were independent predictors of ACL injury. For the ACL injury cohort, multivariable regression was again conducted to determine independent predictors of concomitant meniscus tears (any tear, medial tear, lateral tear or both sides tear). Finally, receiver-operating characteristic (ROC) curves were constructed to determine which parameters were most predictive of ACL injury and ACL injury with or without associated meniscal injury. There were 161 patients with MRI demonstrating a torn ACL available for analysis, including 101 males (median age, 25; interquartile range [IQR], 18–31) and 60 females (median age, 26.5; IQR, 16.25–37). An age-matched cohort 65 males (median age, 26; IQR, 18.5–37) and 74 females (median age, 28; IQR, 16–37), 139 in total, served as controls. In univariate analysis, medial femoral condyle (MFC) width, lateral tibial plateau (LTP) width, and lateral femoral condyle (LFC) percentage were significantly higher in the ACL-tear cohort overall relative to controls, while medial tibial plateau (MTP) slope, LTP slope, and tibial tubercle-trochlear groove distance were significantly lower, though some variation was observed when stratified by sex (Tables 1 and 2). There were significant differences in MFC width, MTP width, MTP slope, LTP slope, TT-TG distance, LFC percentage, and MFC/MTP in patients with concomitant ACL and meniscus injuries (Table 3). Multivariable analysis revealed multiple parameters which were independently associated with ACL tears overall, ACL tears in males, ACL tears in females, ACL tears with concomitant meniscal tears (medial or lateral), ACL tears with concomitant lateral meniscus tears, and ACL tears with concomitant medial and lateral meniscus tears (Table 4). ROC analysis identified MTP slope as most predictive of ACL injury, overall as well as for males and females separately; age as most predictive of ACL with any concomitant meniscal injury, ACL with concomitant lateral meniscus injury, and ACL with both medial and lateral meniscus injury; and MFC width as most predictive of ACL with concomitant medial meniscus injury (Figure 1). In a large cohort of ACL tears with age-matched controls, our analysis identified multiple radiographic parameters which were significantly associated with ACL injuries when compared with the controls. Additionally, we identified significant differences and variation in these parameters among patients with ACL tears and concomitant meniscal injuries. These results may help identify anatomic risk factors which place some patients at relatively greater risk for failure after surgical treatment of ACL ruptures. Recognition of these risk factors could guide surgical decision making and rehabilitation protocols.

A real 3D measurement technique for the tibial slope: differentiation between different articular surfaces and comparison to radiographic slope measurement

BackgroundThe tibial slope plays an important role in knee surgery. However, standard radiographic measurement techniques have a low reproducibility and do not allow differentiation between medial and lateral articular surfaces. Despite availability of three-dimensional imaging, so far, no real 3D measurement technique was introduced and compared to radiographic measurement, which were the purposes of this study.MethodsComputed tomography scans of 54 knees in 51 patients (41 males and 10 females) with a mean age of 46 years (range 22–67 years) were included. A novel 3D measurement technique was applied by two readers to measure the tibial slope of medial and lateral tibial plateau and rim. A statistical analysis was conducted to determine the intraclass correlation coefficient (ICC) for the new technique and compare it to a standard radiographic measurement.ResultsThe mean 3D tibial slope for the medial plateau and rim was 7.4° and 7.6°, for the lateral plateau and rim 7.5° and 8.1°, respectively. The mean radiographic slope was 6.0°. Statistical analysis showed an ICC between both readers of 0.909, 0.987, 0.918, 0.893, for the 3D measurement of medial plateau, medial rim, lateral plateau and lateral rim, respectively, whereas the radiographic technique showed an ICC of 0.733.ConclusionsThe proposed novel measurement technique shows a high intraclass agreement and offers an applicable opportunity to assess the tibial slope three-dimensionally. Furthermore, the medial and lateral articular surfaces can be measured separately and one can differentiate the slope from the plateau and from the rim. As three-dimensional planning becomes successively more important, our measurement technique might deliver a useful supplement to the standard radiographic assessment in slope related knee surgery.Level of evidenceLevel III, diagnostic study.

Patients With Failed Anterior Cruciate Ligament Reconstruction Have an Increased Posterior Lateral Tibial Plateau Slope: A Case-Controlled Study

To compare knee anatomical parameters of patients with failed anterior cruciate ligament reconstruction (ACL-R) with those of a control group of sex-matched patients with successful ACL-R. Forty-three patients (34 male, 9female) who experienced graft failure after ACL-R were enrolled in the failed group. These patients were matched to a control group of 43 patients who underwent primary ACL-R with a minimum follow-up of 24months. On magnetic resonance imaging, the following parameters were evaluated: transepicondylar distance, lateral and medial femoral condyle widths, tibial plateau width, notch width index, and the ratio of width and height of the femoral notch, ratio between the height and depth of the lateral and medial femoral condyle, lateral and medial posterior tibial slopes, and anterior subluxation of the lateral and medial tibial plateau. Multivariate regression with backward elimination, including only the previously identified significant variables, defined the independent predictors for revision surgery. The anatomical variables that were significantly different between the 2 study groups were lateral and medial posterior tibial slopes, anterior subluxation of the lateral and medial tibial plateau, medial tibial plateau width, lateral tibial plateau width, medial femoral condyle width, and transepicondylar distance; however, the multivariate regression analysis identified the lateral posterior tibial slope (LTPs), the anterior subluxation of the medial tibial plateau, and the medial femoral condyle width as significant independent predictors (P < .05). The LPTs had the highest coefficient and the highest sensitivity (88%) and specificity (84%) to identify failures when considering the optimal cutoff value of 7.4°. Several anatomical parameters have been identified that differ significantly between patients with failed ACL-R and those without a documented failure. The most accurate predictor of ACL failure was an LTPs >7.4°, with a sensitivity of 88% and specificity of 84%. Surgeons should consider measuring LTPs during preoperative assessment of ACL-injured patients, and patients with values >7.4° should be considered at high risk of ACL-R failure. Level III retrospective prognostic trial.

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.

Anatomical Risk Factors of Anterior Cruciate Ligament Injury.

Background:Nowadays, the anterior cruciate ligament (ACL) injury has been one of the most common diseases of the knee joint. The relationships between the ACL injury and the anatomical structures are still controversial. This study aimed to identify the anatomical risk factors of ACL injury by magnetic resonance imaging (MRI) of the knee.Methods:This was a retrospective study of 125 patients undergoing primary ACL reconstruction between July 2013 and May 2017. Another 125 patients without any organic knee joint injury were served as controls. The shape of intercondylar notch, the intercondylar notch width index, the intercondylar notch height index, the α angle, the β angle, and the medial and lateral tibial plateau slope were measured with MRI and compared. The data were compared by binary logistic regression to find the risk factors.Results:The two groups differed in the proportion of male patients (70.4% vs. 52.0%, χ2 = 8.911, P = 0.003), but gender was excluded as a risk factor for ACL injury with regression analysis (odds ratio = 1.476, 95% confidence interval [CI]: 0.689–3.160, P = 0.317). The injured group was found to have a smaller notch width index (95% CI = 7.960E-23–2.154E-9, P < 0.001), a larger β angle (95% CI = 1.311–1.785, P < 0.001), and a larger lateral tibial plateau slope (95% CI = 1.201–1.683, P < 0.001). The cutoff values of notch width index, β angle, and the lateral tibial plateau slope were 0.252, 38.5°, and 7.5°, respectively.Conclusions:In this study, a narrow intercondylar notch (intercondylar notch width index <0.252), a larger lateral tibial slope (>7.5°), and larger β angle (>38.5°) might be the factors associated with ACL injury.Trial Registration:ChiCTR-RRC-17014116; http://www.chictr.org.cn/showproj.aspx?proj=24119 .

RISK FACTORS ASSOCIATED WITH NON-CONTACT ANTERIOR CRUCIATE LIGAMENT INJURY: A SYSTEMATIC REVIEW

With the increasing number of individuals participating in sports every year, injury - specifically anterior cruciate ligament (ACL) injury - remains an inherent risk factor for participants. The majority of ACL injuries occur from a non-contact mechanism, and there is a high physical and financial burden associated with injury. Understanding the risk factors for ACL injury may aid in the development of prevention efforts. The purpose of this review was to synthesize and appraise existing literature for risk factors associated with non-contact anterior cruciate ligament (ACL) injury in both sexes. Systematic review. An electronic literature search was conducted utilizing the MEDLINE database and The Cochrane library for articles available through February 2016. All titles and abstracts were reviewed and full text articles meeting eligibility criteria were assessed in detail to determine inclusion or exclusion. Articles reviewed in full text were reviewed for scientific evidence of risk factors for ACL injury. Results from studies were extracted and initially classified as either intrinsic or extrinsic risk factors, and then further categorized based upon the evidence presented in the studies meeting inclusion criteria. Data extracted from eligible studies included general study characteristics (study design, sample characteristics), methodology, and results for risk factors included. Principal findings of this systematic review identified the following risk factors for ACL injury in both sexes: degrading weather conditions, decreased intercondylar notch index or width, increased lateral or posterior tibial plateau slope, decreased core and hip strength, and potential genetic influence. Neuromuscular and biomechanical risk factors may be addressed through neuromuscular preventative training programs. Though some extrinsic and other inherent physiological factors tend to be non-modifiable, attempts to improve upon those modifiable factors may lead to a decreased incidence of ACL injury. 2a.

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.