Proximal tibial bony anatomy may predict risk of posterior meniscal root tears
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Key takeaways:
- Medial, lateral and lateral-to-medial tibial slope asymmetries may predict risk of meniscus injury.
- Surgeons should consider bony anatomy when treating meniscus tears.
Medial, lateral and lateral-to-medial tibial slope asymmetries may be associated with an increased risk of posterior meniscal root tears, according to results published in the American Journal of Sports Medicine.
Researchers from Midwest Orthopaedics at Rush University Medical Center performed a systematic review of 10 studies that analyzed a total of 600 patients with medial meniscus posterior root tears, 284 patients with lateral meniscus posterior root tears and a control group of 429 patients without meniscal root injury.
According to the study, MRI and plain lateral radiographs were used to measure posterior tibial slope, medial tibial slope, lateral tibial slope, coronal tibial slope and lateral-to-medial tibial slope.
Researchers found patients with lateral meniscus posterior root tears had a significantly greater mean lateral tibial slope (7.3° vs. 5.7°), medial tibial slope (5.26° vs. 4.8°) and lateral-to-medial asymmetry (2.3° vs. 0.65°) compared with the control group. They found patients with medial meniscus posterior root tears had significantly greater mean medial tibial slope (8.1° vs. 4.3°) compared with the control group.
Researchers noted patients with lateral meniscus posterior root tears had higher incidences of noncontact injuries and concomitant ramp lesions compared with patients with medial meniscus posterior root tears and patients in the control group.
“Identifying proximal tibial morphology as an anatomic propensity for lateral and medial root injuries is important to increase awareness and serves as a foundation for future studies on how bony anatomy may influence treatment,” the researchers wrote in the study.
Perspective
Back to TopRobert F. LaPrade, MD, PhD, and Luke Tollefson, BS
The article “Increased posterior tibial slope is associated with increased risk of meniscal root tears” by Jorge Chahla MD, PhD, and colleagues helps to assimilate data in the literature on the fact that increased posterior tibial slope is not only associated with ACL tears, but also with meniscal root tears.
Increased posterior tibial slope places increased stress on the ACL, which has been documented to both increase the risk of an ACL tear, as well as to place an ACL reconstruction graft at an increased risk of attenuation or a retear. The information presented in this article summarizes information that should be intuitive: The anteriorly directed stress that is present on the knee with an increased posterior tibial slope can also put extra stress on the posterior meniscal root attachments.
This information should prove useful for the clinical assessment of meniscal root tears, especially those that occur concurrent with an ACL tear, even prior to obtaining an MRI scan. In patients with minimal joint line pain, but who have increased posterior knee pain, especially with squatting activities, one can assess the posterior tibial slope of the knee to help improve one’s diagnostic capabilities for a root tear. In addition, it is well documented that in patients with an ACL tear, a Lachman or pivot shift test that is a 3+ is not just an ACL tear; it is an “ACL+” in that something else needs to be injured to achieve that increase in abnormal motion.
Assessing posterior tibial slope can help improve one’s diagnostic capabilities for posterior meniscal root tear.
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