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CC BY-NC-ND 4.0 · Joints 2019; 07(03): 078-083
DOI: 10.1055/s-0040-1710386
Original Article

The Role of the Posterolateral Tibial Slope in the Rotational Instability of the Knee in Patients Affected by a Complete Isolated Anterior Cruciate Ligament Injury: Its Value in the Decision-Making Process during the Anterolateral Ligament Reconstruction

Marco Bargagliotti 
1   Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Francesco Benazzo 
2   Orthopedic and Sport Traumatology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
,
Johan Bellemans
3   Orthopedic and Sport Traumatology Department, Ziejenhuis Oost-Limburg Hospital, Genk, Belgium
,
Jan Truijen
3   Orthopedic and Sport Traumatology Department, Ziejenhuis Oost-Limburg Hospital, Genk, Belgium
,
Luigi Pietrobono
4   Radiology and Neuroradiology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
,
Mario Formagnana
5   Ospedale Civile Edoardo Agnelli, Pinerolo, Italy
,
Enrico Zero
6   Department of Informatics, Bioengineering, Robotics and System Engineering of the University of Genoa, Genoa, Italy
,
Giacomo Zanon
2   Orthopedic and Sport Traumatology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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Abstract

Purpose The aim of this retrospective, multicenter study was to investigate the correlation between a high degree of rotatory instability, posterolateral tibial slope (PLTS), and anterolateral ligament (ALL) injury.

Methods The study population consisted of 76 adults with isolated, complete noncontact anterior cruciate ligament (ACL) tear. The sample was divided into two groups according to the preoperative degree of rotator instability (group A: pivot-shift test grades 2 and 3; group B: pivot-shift test grade 1). Preoperative magnetic resonance imaging (MRI) assessment included angle of PLTS, posterior shift of the lateral femoral condyle (16 mm) on the tibial plateau, and the presence/absence of ALL injury. The two groups were compared for differences.

Results There was a statistically significant association between pivot-shift test grades 2 and 3 (group A), PLTS slope angle > 9 degrees, and ALL injury (p < 0.05). Group A also demonstrated a greater posterior shift of lateral femoral condyle (>11 mm), which was, however, not statistically significant when evaluated as an isolated variable.

Conclusion Our study indicates that an increased PLTS is associated with an increased incidence of ALL injury and an increased grade of pivot shift in patients with ACL tear. Assessment of posterolateral tibial slope on MRI can therefore play a key adjunct role in the surgical planning of ALL reconstruction, especially in cases when ALL damage is radiologically difficult to detect or doubtful.

Level of Evidence This is a retrospective comparative level III study.

Keywords

anterior cruciate ligament - tibial slope - pivot shift - rotational instability - posterior femoral shift


Publication History

Received: 04 March 2019

Accepted: 04 April 2020

Article published online:
18 May 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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