Tibial Plateau Slope Research Articles

The Traditional Intramedullary Axis Underestimates the Medial Tibial Slope Compared to Transmalleolar Sagittal Axis in Image-based Robotic-Assisted Unicompartimental Knee Arthroplasty.

The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.

Single-bundle ACL combined with ALL reconstruction yields comparable outcomes in patients with varied anatomical risk factors for ACL graft failure

BackgroundAnterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure.Patients and methodsA total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively.ResultsThe average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury (p = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury (p = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° (p = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° (p = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC (R = -0.058, p = 0.365), Lysholm (R = -0.017, p = 0.459), or Tegner activity scores (R = -0.147, p = 0.189).ConclusionOur study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making.Level of evidenceLevel 3.

Poster 320: Combined Role of Tibial Cartilage Slope, Knee Laxity, and Lower Extremity Strength as Risk Factors for First-Time, Noncontact ACL Injury in Female Athletes

Objectives: Univariable analyses of knee geometry, anteroposterior (AP) laxity, and muscular strength have revealed associations with risk of first-time, noncontact ACL injury in females. However, multivariable analyses assessing the risk associated with combinations of these factors have been limited. As a result, it is unclear how these factors act interdependently to exacerbate or attenuate risk of injury. Therefore, the purpose of this study was to characterize the risk of first-time, noncontact ACL injury associated with pairwise combinations of factors related to geometry, laxity, and strength. Methods: First-time, noncontact ACL injury events were identified as they occurred in 61 female high school and collegiate athletes over a four-year period. Simultaneously, 61 sex- and age-matched control subjects, with no history of lower extremity injury, were selected from the same team. Magnetic resonance imaging was acquired bilaterally, and articular geometries were obtained. On contralateral, uninjured case and control knees, AP knee translation was measured using a KT-2000 arthrometer, knee flexion strength was measured with a Biodex System 2, and hip adduction strength was measured using a fixated, isometric dynamometer. Six features were considered: (1) slope of the lateral tibial plateau articular cartilage not covered by meniscus (“middle cartilage slope”) and (2) covered by the posterior horn of the meniscus (“posterior cartilage slope”), (3) AP translation of the tibia relative to the femur, (4) posterior stiffness, (5) knee flexion strength, and (6) hip adduction strength. First, each feature was compared between cases and controls using Student’s t-test (α = 0.05). Next, the features were used to build a generalized additive model with two pairwise interactions, with ACL injury as the dependent variable. Univariable relationships between each feature and absolute risk of ACL injury, as well as pairwise interaction effects, were inspected with partial dependence plots, which describe the (potentially nonlinear) shape of those associations. Absolute risk was defined as the change in probability of experiencing an ACL injury associated with varying values of each feature, accounting for the average effect of all other features. For example, an absolute risk value of 0.2 signifies a 20% increase in absolute risk. Results: Compared to their uninjured teammates, injured athletes had greater middle cartilage slope (0.6° ± 3.8° vs. -3.8° ± 4.2°, p < 0.001) and greater posterior cartilage slope (13.3° ± 6.3° vs. 8.5° ± 5.5°, p < 0.001) of the lateral tibial plateau. Injured subjects also had greater AP laxity (15.0 ± 3.0 mm vs. 13.6 ± 2.4 mm, p = 0.006) than uninjured controls. Partial dependence plots for each of the six features show associations with absolute risk (Figure 1). The two pairwise interaction effects identified were lateral middle cartilage slope with hip adduction strength (Figure 2) and lateral posterior cartilage slope with AP translation (Figure 3). The first revealed that the increase in risk associated with increasing middle tibial cartilage slope was larger in athletes with decreased hip adduction strength (and smaller in athletes with increased hip adduction strength). The second revealed that the increase in risk associated with increasing posterior tibial cartilage slope was larger in athletes with increased AP translation (and smaller in athletes with decreased AP translation). Conclusions: In this cohort of high school and collegiate female athletes, the model revealed two important interactions among lateral tibial cartilage slope, hip adduction strength, and knee laxity. Increased hip adduction strength and decreased AP translation both acted in combination to decrease risk of first-time, noncontact ACL injury in athletes with greater cartilage slope. The risk associated with increased middle cartilage slope may be reduced in athletes with greater hip adduction strength (Figure 2). This could be explained by an increase in femoral stability with stronger muscular forces. Moreover, clinicians should pay close attention to patients presenting with increased AP translation and greater posterior cartilage slope, as these features interacted to exacerbate risk of injury in our cohort (Figure 3). Conversely, decreased AP translation may stabilize the knee in the presence of greater posterior cartilage slope, reducing the risk associated with this geometry. In assessing risk of first-time, noncontact ACL injury, lateral tibial cartilage slope measurements should be considered in conjunction with laxity- and strength-related factors. [Figure: see text][Figure: see text][Figure: see text]

Anterior Opening-Wedge Proximal Tibial Osteotomy for Slope Correction of Genu Recurvatum

Background: Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. In instances where the genu recurvatum is caused by reverse tibial slope, literature supports the use of anterior opening-wedge proximal tibial osteotomy (OW PTO) to treat genu recurvatum by increasing tibial slope. Correction of anterior slope to a more anatomic, posterior orientation allows any stressed ligaments to return to their normal tension and restores the native biomechanics of the knee. Indications: The primary indication for OW PTO is genu recurvatum that is nonresponsive to physical therapy or genu recurvatum with concurrent ligamentous injury. The heel-height test provides an objective assessment for the identification and measurement of knee hyperextension. Technique Description: 2 guide pins are placed parallel to the tibial plateau, engaging the posterior cortex. A small micro sagittal saw is used to cut the anterior cortex. Osteotomes are used to complete the osteotomy, preserving a posterior hinge. An opening spreader device is placed and opened slowly while keeping the posterior cortex intact. The new slope is maintained by use of an opening wedge osteotomy plate and screws. Allograft bone graft is packed thoroughly into the osteotomy site. Fluoroscopy is used throughout the case to assess appropriate orientation and depth of the osteotomy, as well as the final opening width. Results: A review of 5 studies demonstrated adequate reduction in hyperextension, with a mean knee hyperextension ranging from 17° to 32° preoperatively and 0° to 7° postoperatively. Patients had significantly improved postoperative clinical outcomes compared with the preoperative state. Discussion/Conclusion: Anterior OW PTO has been shown to be a safe method of accurately correcting tibial plateau slope for the treatment of genu recurvatum. Patients can expect correction of knee hyperextension, restoration of anatomic posterior tibial slope, decreased posterior tibial translation, and increased subjective outcome scores. Patient Consent Disclosure Statement: The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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.

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.

Comparative digital study of two cranial rotation methods of the proximal fragment on the center of rotation of angulation-based leveling osteotomy planning with different tibial distal anatomical axes

The center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) technique was developed for cranial cruciate ligament (CrCL) rupture treatment, aiming to modify the mechanical-anatomical angle (AMA), which is described as a predictive risk factor for the disease and is recommended to be taken into consideration when one is choosing a surgical procedure for tibial plateau slope alteration. Identifying a tibial distal anatomical axis (DAA) is essential in CBLO surgical planning and measuring AMA amplitude. The aim of this study was: to evaluate two methods of cranial rotation of the proximal fragment using four different tibial distal anatomical axes for digital planning on the CBLO technique, comparing its effectiveness in achieving the desired tibial plateau angle (TPAd) and closing the AMA angle. Tibial measurements were made with the vPOP pro software using 30 mediolateral radiographs of canine stifles. The DAA described by four authors was used based on the amount of Rotation completed (Rc) for each. The rotation methods evaluated were: 1) commercial CBLO table (RT) and 2) overlapping the tip of the intercondylar eminence with the corresponding DAA line (RE). The TPAd to be obtained was fixed at 10°, and the final AMA to be achieved at 0°. The mean values and standard deviations of the final TPA and final AMA with the rotation method were TPA(RT)f(%TPAd), TPA(RE)f(%TPAd), AMA(RT)f(%AMAzero), AMA(RE)f(%AMAzero). The results of each author were Hulse 10.0 ± 0.3(46.6%), 9.9 ± 0.1(60%), 0.3 ± 0.3(33.3%), 0.3 ± 0.3(13.3%), Osmond 10.1 ± 0.2(75%), 10,1 ± 0.2(83.3%), 0.4 ± 0.4(33.3%), 0.4 ± 0.3(8,3%), Miles 10.0 ± 0.1(66.6%), 10.0 ± 0.1(75%), 0.2 ± 0.1(16.6%), 0.2 ± 0.1(8.3%), Tudury 9.6 ± 0.6(31.2%), 9.5 ± 0.2(31.2%), 1.0 ± 0.7(18.7%), 1.0 ± 0.6(12.5%), respectively. The initially described RT obtained a higher percentage of AMA at zero degrees. Therefore, the RE method is discarded for use as an alternative to CBLO planning.

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.

Poster 140: The Effect of Posterior Tibial Slope and Flexion Angle on Posterior Medial Meniscal Root Forces

Objectives: Although the biomechanical and clinical consequences of posterior medial meniscal root (PMMR) tears have been previously reported, these have not been fully evaluated in terms of overall bony morphology. It is well documented that higher flexion angles lead to higher postero-medial pressure, with many groups proposing that PMMR tears are caused by elevated compression and shear forces at the root when the loaded knee is at high flexion angles. Additionally, several authors have advocated that increasing tibial plateau slope (PTS) is an anatomical risk factor for PMMR tears, due to the higher posterior shear forces at the root insertion site. Thus, the purposes of this study are to evaluate the forces across the PMMR utilizing a novel three-dimensional forces sensor with varying posterior tibial slopes and flexion angles. We hypothesized that an increased flexion angle and/or posterior tibial slope will result in increased posterior shear forces acting on the PMMR. Methods: Ten fresh-frozen cadaveric knees (53.2 mean age, all male) were tested in all combinations of the three states of posterior tibial slope (5⁰, 10⁰, 15⁰) and the four states of varying flexion angles (0⁰, 30⁰, 60⁰, and 90⁰). A novel three-axis sensor that determines force measurements in three orthogonal directions was installed below the posterior tibial plateau, with the specimen being mounted to a load frame which applied a 500-N axial load. A 5-Nm internal rotational (IR) torque was then applied. After the IR torque, a 5-Nm external rotational torque was applied. The amount of compression-tension and shear forces acting on the PMMR were measured. Results: Increased tibial slope significantly decreased tension and significantly increased compression of the PMMR (5°→10°: p = 0.0368, 5°→15°: p &lt; 0.0001, 10°→15°: p &lt; 0.0001) when the joint was loaded in compression. Increased tibial slope significantly increased anterior shear of the PMMR (5°→10°: p &lt; 0.0001, 5°→15°: p &lt; 0.0001, 10°→15°: p &lt; 0.0001) when the joint was internally rotated. Increased tibial slope significantly decreased compression of the PMMR (5°→10°: p = 0.0188, 5°→15°: p &lt; 0.0001) when the joint was externally rotated. Increased flexion angle significantly increased medial shear forces of the PMMR (0°→30°: p = 0.0362, 0°→60°: p = 0.0005, 0°→90°: p &lt; 0.0001, 30°→90°: p = 0.0434) when the joint was loaded in compression. 90° of flexion significantly increased tension of the PMMR (0°→90°: p = 0.0438, 30°→90°: p &lt; 0.0001, 60°→90°: p = 0.0005) when the joint was internally rotated. 30° of flexion angle significantly increased compression of the PMMR (0°→30°: p = 0.0004, 30°→60°: p = 0.0118, 30°→90°: p &lt; 0.0001) when the joint was externally rotated. Conclusions: Increased PTS results in an increase in compression forces acting on the posterior horn of the medial meniscus when the knee joint is loaded. Increases in flexion angles displays an increase in medial shear forces seen at the PMMR under a load. This increase in force may place the PMMR at increased risk of stress and potential failure after repair. This study begins to provide clinicians with information to create safer protocols to decrease the forces experienced at the PMMR after injury or postoperatively.

What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study.

Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery. The online version contains supplementary material available at 10.1007/s43465-023-00888-5.

The Risk Factor Analysis of Femorotibial Joint Morphometrics Associated with Severity of Anterior Cruciate Ligament Tear Using MRI Examination: Study in Indonesia

BACKGROUND: Anterior cruciate ligament (ACL) tear is a condition that has been linked to both short-term and long-term clinical outcomes and has an anatomical risk factor known as femorotibial joint morphometrics. There are three grades of this condition, which are sometimes difficult to detect through imaging. AIM: This study aimed to analyze the prevalent ratio (PR) of femorotibial joint morphometrics to ACL tear grades using magnetic resonance imaging (MRI). METHODS: An observational approach along with a cross-sectional design was employed. The ACL tear grade and measurement of bi-intercondylar width (BCW), North width (NW), NW index (NWI), tibial plateau slope (TPS), tibial plateau depth (TPD), tibial eminence width (EW), and tibial EW index (EWI) were retrospectively evaluated in 48 patients using knee MRI with new non-contact ACL tear aged above 18 years. The Chi-square test was the statistical analysis used to measure PR. RESULTS: The number of subjects presented with ACL tear grade I-II and III was 16 and 32, respectively. The PR value of lateral TPS to ACL tear grades and the lowest 95% confidence interval (CI) were both greater than one, and hence, significant. However, the PR values of BCW, NW, NWI, and medial TPS to ACL tear grades were greater than one, but the lowest 95% CI was less than one, and hence, not significant. Finally, the PR values of TPD, EW, and EWI could not be determined in this study. CONCLUSION: The lateral TPS had a PR value greater than one, indicating that it is considered a risk factor for ACL tear grade III.

Corrective Osteotomy in a Dog to Address Increased Distal Femoral Procurvatum Ascribed to a Distal Femoral Salter-Harris Type V Injury

AbstractIncreased distal femoral procurvatum has been reported sporadically in dogs following malunion of Salter-Harris type I, II, and III fractures of distal femur. The resultant increased procurvatum can be poorly tolerated because of subsequent loss of stifle extension. This case report represents a dog with the increased procurvatum of the distal femur ascribed to a previous Salter-Harris type V injury. Surgical planning and successful outcome following the corrective procedures have been documented. A 6.5-month-old fox-terrier presented with a persistent weight bearing left pelvic limb lameness, 2 months after being hit by a car. The predominant orthopaedic finding was a 20-degree decrease in left stifle extension. Radiographic and computerized tomography evaluation revealed premature eccentric closure of the left distal femoral physis ascribed to a previous Salter-Harris type V injury. The left femoral procurvatum was 30 degrees. The left tibial plateau angle was increased by 11.5 degrees compared with the right. The femoral deformity was characterized, and a corrective procedure was planned using Paley's centre of rotation of angulation methodology. A cranial closing wedge ostectomy of the left distal femur was performed and stabilized using a locking plate. Proximal tibial epiphysiodesis was also performed to reduce the tibial plateau slope. Union of the osteotomy site and reduction in tibial plateau angle by 5.4 degrees were documented 50 days after surgery with a good functional outcome.

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.

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