Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(01): 047-052
DOI: 10.1055/s-0040-1712495
Artigo Original
Joelho

Analysis of Posterior Tibial Slope as Risk Factor to Anterior Cruciate Ligament Tear

Article in several languages: português | English
Pedro Guilme Teixeira de Sousa Filho 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
2   Grupo GENU, Fortaleza, CE, Brasil
,
Andre Cavalcante Marques 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Leonardo Soares Pereira 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Breno Almeida Pigozzo 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Rodrigo Sattamini Pires e Albuquerque 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination.

Methods Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age.

Results Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8°, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8° (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8.

Conclusion It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8°.

Keywords

anterior cruciate ligament - ligaments - knee injuries - tibia


Publication History

Received: 08 March 2019

Accepted: 20 February 2020

Article published online:
22 September 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 1980; 62 (02) 259-270
    CrossrefPubMedGoogle Scholar
  • 2 Dargel J, Gotter M, Mader K, Pennig D, Koebke J, Schmidt-Wiethoff R. Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strateg Trauma Limb Reconstr 2007; 2 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 3 Dennis DA, Mahfouz MR, Komistek RD, Hoff W. In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 2005; 38 (02) 241-253
    CrossrefPubMedGoogle Scholar
  • 4 Logan M, Dunstan E, Robinson J, Williams A, Gedroyc W, Freeman M. Tibiofemoral kinematics of the anterior cruciate ligament (ACL)-deficient weightbearing, living knee employing vertical access open “interventional” multiple resonance imaging. Am J Sports Med 2004; 32 (03) 720-726
    CrossrefPubMedGoogle Scholar
  • 5 Domnick C, Raschke MJ, Herbort M. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques. World J Orthop 2016; 7 (02) 82-93
    CrossrefPubMedGoogle Scholar
  • 6 Wordeman SC, Quatman CE, Kaeding CC, Hewett TE. In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 2012; 40 (07) 1673-1681
    CrossrefPubMedGoogle Scholar
  • 7 Smith HC, Vacek P, Johnson RJ. et al. Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports Health 2012; 4 (01) 69-78
    CrossrefPubMedGoogle Scholar
  • 8 Zeng C, Cheng L, Wei J. et al. The influence of the tibial plateau slopes on injury of the anterior cruciate ligament: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 53-65
    CrossrefPubMedGoogle Scholar
  • 9 Fening SD, Kovacic J, Kambic H, McLean S, Scott J, Miniaci A. The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. J Knee Surg 2008; 21 (03) 205-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 1994; 76 (05) 745-749
    CrossrefPubMedGoogle Scholar
  • 11 Torzilli PA, Deng X, Warren RF. The effect of joint-compressive load and quadriceps muscle force on knee motion in the intact and anterior cruciate ligament-sectioned knee. Am J Sports Med 1994; 22 (01) 105-112
    CrossrefPubMedGoogle Scholar
  • 12 Voos JE, Suero EM, Citak M. et al. Effect of tibial slope on the stability of the anterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1626-1631
    CrossrefPubMedGoogle Scholar
  • 13 Hohmann E, Bryant A, Reaburn P, Tetsworth K. Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries?. Knee Surg Sports Traumatol Arthrosc 2011; 19 (Suppl. 01) S109-S114
    CrossrefPubMedGoogle Scholar
  • 14 Alentorn-Geli E, Mendiguchía J, Samuelsson K. et al. Prevention of anterior cruciate ligament injuries in sports. Part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 3-15
    CrossrefPubMedGoogle Scholar
  • 15 Dejour H, Walch G, Chambat P, Ranger P. Active sub-luxation in extension: a new concept of study of the ACL-deficient knee. Am J Knee Surg 1988; 1: 204-211
    Google Scholar
  • 16 Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 2004; 32 (02) 376-382
    CrossrefPubMedGoogle Scholar
  • 17 Hohmann E, Bryant AL. Closing or opening wedge high tibial osteotomy: watch out for the slope. Oper Tech Orthop 2007; 17 (01) 17-38
    CrossrefGoogle Scholar
  • 18 Liu W, Maitland ME. Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Ann Biomed Eng 2003; 31 (10) 1153-1161
    CrossrefPubMedGoogle Scholar
  • 19 McLean SG, Lucey SM, Rohrer S, Brandon C. Knee joint anatomy predicts high-risk in vivo dynamic landing knee biomechanics. Clin Biomech (Bristol, Avon) 2010; 25 (08) 781-788
    CrossrefPubMedGoogle Scholar
  • 20 Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2846-2852
    CrossrefPubMedGoogle Scholar
  • 21 Sonnery-Cottet B, Archbold P, Cucurulo T. et al. The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament. J Bone Joint Surg Br 2011; 93 (11) 1475-1478
    CrossrefPubMedGoogle Scholar