Elevated posterior tibial slope increased risk for revision ACL failure
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NASHVILLE, Tenn. — An elevated or “steep” posterior tibial slope, confirmed with imaging, increased the graft re-rupture risk in patients undergoing revision ACL reconstruction, according to an orthopedic sports medicine specialist.
“We know from biomechanical studies that increased tibial slope is associated with increased anterior tibial translation, as well as strain in the ACL,” Robert A. Duerr, MD, an orthopedic surgeon at Ohio State University Wexner Medical Center, said in his presentation at the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting. “There have also been clinical studies that have shown elevated tibial slope both in ACL primary injuries, ACL graft failures and in multiple ACL graft failures.”
Duerr and colleagues retrospectively reviewed data from matched cohorts of 38 cases of revision ACL graft failure and 38 control cases with a minimum 2-year follow-up. Researchers used lateral knee radiographs and MRI to assess posterior tibial slope (PTS).
“We did 5 cm below the joint line and the lowest visualized portion to define tibial anatomic axis, and an angle formed at the tangent of the medial and lateral plateaus,” Duerr added.
Researchers noted MRI and radiographic measurements demonstrated “significantly elevated” PTS in the revision failure cohort vs. the control cohort. Radiographic results showed patients with a medial PTS of 14° or more or lateral PTS of 13° or more had an increased risk for revision ACL failure. Additionally, MRI results showed patients with a medial PTS of at least 5° or lateral PTS of at least 6.5° also had an increased risk for graft failure.
Overall, Duerr concluded that patients with radiographic medial PTS of 14° or more had 18.7-times greater odds of revision ACL graft failure compared with the controls.
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Duerr RA, et al. Increased posterior tibial slope is associated with revision anterior cruciate ligament reconstruction graft re-rupture. Presented at: American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting; July 7-11, 2021; Nashville, Tennessee.
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