Relationship of ACL Injury and Posterior Tibial Slope With Patient Age, Sex, and Race

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2016 Dec 9

PMID 27928547

Citations 18

Authors

Alana Waiwaiole

Ajay Gurbani

Kambiz Motamedi

Leanne Seeger

Myung Shin Sim

Patricia Nwajuaku

Sharon L Hame

Affiliations

Soon will be listed here.

Abstract

Background: Posterior tibial slope (PTS) has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury; however, studies that have examined this relationship have provided inconclusive and sometimes contradictory results. Further characterization of this relationship may enable the medical community to identify individuals at greater risk for ACL injury and possibly characterize an anatomic target during surgical reconstruction.

Purpose: The primary goal was to investigate the relationship between PTS and ACL injury. The secondary goal was to determine whether there are any patient factors, such as age, race, or sex, that correlate with ACL injury and PTS.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Medical records of 221 patients who underwent magnetic resonance imaging (MRI) of the knee between January 2003 and December 2009 were reviewed. Patients were separated into 2 groups: a study group of those subjects who had undergone surgery for ACL injury (n = 107) and a control group of patients diagnosed with patellofemoral syndrome (n = 114). Demographic data were collected, and MRI images from both groups were analyzed using imaging software to obtain medial and lateral tibial slope measurements. Data were then analyzed using analysis of variance (ANOVA) comparison and a multivariable regression model to determine which, if any, patient factors were related to probability of having an ACL injury.

Results: ANOVA comparison demonstrated that the study group had significantly greater values for lateral PTS (6° ± 4°; < .001) and medial PTS (7° ± 4°; = .002) compared with controls (5° ± 3° and 5° ± 4°, respectively). After stepwise elimination of nonsignificant variables, the final multivariable logistic regression model determined that age (odds ratio [OR], 0.94; < .001) and lateral PTS (OR, 1.12; = .002) had statistically significant relationships with ACL injury. Medial PTS, race, and sex were not demonstrated to be significant predictors of ACL injury in this final model.

Conclusion: This study demonstrates a relationship between increased lateral PTS and ACL injury, which corroborates the findings of previously published studies. The findings presented in this article may help identify patients who are at greater risk of ACL injury and could potentially benefit from treatments aimed at modification of PTS.

Citing Articles

Slope of the Medial Tibial Plateau and the Incidence of a Medial Meniscal Tear.

Askari A, Mirkamali S, Ghaderi M, Arasteh P, Mohammadpour M Arch Bone Jt Surg. 2025; 12(11):754-759.

PMID: 39850920 PMC: 11756546. DOI: 10.22038/ABJS.2024.74315.3439.

Association Between Posterior Tibial Slope and Clinical Outcomes After Isolated Anterior Cruciate Ligament Reconstructions.

Kasman U, Surucu S, Korkmaz O Cureus. 2023; 15(10):e46679.

PMID: 37942392 PMC: 10629277. DOI: 10.7759/cureus.46679.

A posterior tibial slope angle over 12 degrees is critical to epiphyseal fracture of the proximal tibia: Three-dimensional finite element analysis.

Watanabe H, Murase K, Kim D, Matsumoto T, Majima T Heliyon. 2023; 9(8):e18854.

PMID: 37593627 PMC: 10428038. DOI: 10.1016/j.heliyon.2023.e18854.

First revision ACL reconstruction combined with tibial deflexion osteotomy improves clinical scores at 2 to 7 years follow-up.

Dejour D, Rozinthe A, Demey G Knee Surg Sports Traumatol Arthrosc. 2023; 31(10):4467-4473.

PMID: 37515616 DOI: 10.1007/s00167-023-07493-x.

Do age, gender, and region affect tibial slope? A multi-center study.

Akcaalan S, Akkaya M, Dogan M, Valdivielso A, Zeiton M, Mohammad H Arch Orthop Trauma Surg. 2023; 143(12):6983-6991.

PMID: 37438581 DOI: 10.1007/s00402-023-04976-x.

References

Bisson L, Gurske-DePerio J . Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: a case-control study. Arthroscopy. 2010; 26(7):901-6. DOI: 10.1016/j.arthro.2009.12.012. View

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 1:S109-14. DOI: 10.1007/s00167-011-1547-4. View

Zeng C, Cheng L, Wei J, Gao S, Yang T, Luo W . The influence of the tibial plateau slopes on injury of the anterior cruciate ligament: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012; 22(1):53-65. DOI: 10.1007/s00167-012-2277-y. View

Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch P . Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res. 2009; 467(8):2066-72. PMC: 2706341. DOI: 10.1007/s11999-009-0711-3. View

Meister K, Talley M, Horodyski M, Indelicato P, Hartzel J, Batts J . Caudal slope of the tibia and its relationship to noncontact injuries to the ACL. Am J Knee Surg. 1998; 11(4):217-9. View

Brandon M, Haynes P, Bonamo J, Flynn M, Barrett G, Sherman M . The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy. 2006; 22(8):894-9. DOI: 10.1016/j.arthro.2006.04.098. View

Sonnery-Cottet B, Mogos S, Thaunat M, Archbold P, Fayard J, Freychet B . Proximal Tibial Anterior Closing Wedge Osteotomy in Repeat Revision of Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2014; 42(8):1873-80. DOI: 10.1177/0363546514534938. View

Marouane H, Shirazi-Adl A, Adouni M, Hashemi J . Steeper posterior tibial slope markedly increases ACL force in both active gait and passive knee joint under compression. J Biomech. 2014; 47(6):1353-9. DOI: 10.1016/j.jbiomech.2014.01.055. View

Dejour H, Bonnin M . Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994; 76(5):745-9. View

10.

Stijak L, Herzog R, Schai P . Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc. 2008; 16(2):112-7. DOI: 10.1007/s00167-007-0438-1. View

11.

Todd M, Lalliss S, Garcia E, DeBerardino T, Cameron K . The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 2009; 38(1):63-7. DOI: 10.1177/0363546509343198. View

12.

Griffin L, Agel J, Albohm M, Arendt E, Dick R, Garrett W . Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000; 8(3):141-50. DOI: 10.5435/00124635-200005000-00001. View

13.

Giffin J, Vogrin T, Zantop T, Woo S, Harner C . Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004; 32(2):376-82. DOI: 10.1177/0363546503258880. View

14.

Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck J, Schutt Jr R . Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med. 2009; 38(1):54-62. DOI: 10.1177/0363546509349055. View