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Xie C, Chen J, Chen H, Zuo Z, Li Y, Lin L. Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management. EPMA J 2025; 16:199-215. [PMID: 39991097 PMCID: PMC11842652 DOI: 10.1007/s13167-025-00399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 01/13/2025] [Indexed: 02/25/2025]
Abstract
Background The 3PM framework revolutionizes disease management by facilitating early risk prediction, disease prevention, and personalized treatment. For isolated incomplete lateral meniscal injuries (IILMI), where early diagnosis is challenging due to non-specific symptoms, 3PM's proactive approach is beneficial in preventing knee joint disease progression and maintaining patients' quality of life. Aims This study aimed to develop a predictive model within the 3PM framework, integrating knee MRI anatomical features with individual physical activity (PA) patterns to enhance early IILMI detection and treatment efficacy, improving patient outcomes and quality of life. Methods The training dataset comprised 254 patients. Using logistic regression analyses and least absolute shrinkage and selection operator (LASSO), IILMI was identified among various preoperative factors containing knee MRI and PA features. A dynamic nomogram was constructed and subjected to internal and external validations (91 patients). Validation encompassed C-index, receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves. ROC analysis determined the risk stratification cut-off. Results Six independent IILMI factors were identified, including PA intensity, PA type, degree of PA intensity, and MRI-derived anatomical parameters. The dynamic nomogram showed high predictive accuracy (C-index, 0.829 in training, 0.906 in validation). IILMI patients were divided into low-risk, medium-risk, and high-risk groups according to the cut-off value. Conclusion In 3PM-guided management, the dynamic nomogram enables early IILMI diagnosis in patients while promoting IILMI stratification making personalized treatment feasible. With further development, it holds promise for effectively predicting IILMI risk, preventing severe knee pathologies, and enhancing the quality of life for at-risk patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-025-00399-3.
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Affiliation(s)
- Chao Xie
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Jingle Chen
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Hantao Chen
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Zhijie Zuo
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Yucong Li
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Lijun Lin
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
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Tsarbou C, Liveris NI, Xergia SA, Papageorgiou G, Kvist J, Tsepis E. ACL Injury Etiology in Its Context: A Systems Thinking, Group Model Building Approach. J Clin Med 2024; 13:4928. [PMID: 39201070 PMCID: PMC11355078 DOI: 10.3390/jcm13164928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation.
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Affiliation(s)
- Charis Tsarbou
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | - Nikolaos I. Liveris
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | - Sofia A. Xergia
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | | | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Elias Tsepis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
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Deng FY, Liu JC, Li Z. Osteotomy combined with anterior cruciate ligament reconstruction for anterior cruciate ligament injury and biplanar deformity. World J Clin Cases 2024; 12:4897-4904. [DOI: 10.12998/wjcc.v12.i22.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury, and varus deformity can aggravate the progression of medial osteoarthritis.
AIM To evaluate the efficacy of modified high tibial osteotomy (HTO) and anterior cruciate ligament reconstruction (ACLR) in the treatment of anterior cruciate ligament (ACL) injuries with varus deformities and increased posterior tibial slope (PTS) based on clinical and imaging data.
METHODS The patient data in this retrospective study were collected from 2019 to 2021. A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS. All patients underwent modified open wedge HTO and ACLR. The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.
RESULTS All 6 patients (6 knee joints) were followed up for an average of 20.8 ± 3.7 months. The average age at surgery was 29.5 ± 3.8 years. At the last follow-up, all patients resumed competitive sports. The International Knee Documentation Committee score increased from 50.3 ± 3.1 to 87.0 ± 2.8, the Lysholm score increased from 43.8 ± 4.9 to 86 ± 3.1, and the Tegner activity level increased from 2.2 ± 0.7 to 7.0 ± 0.6. The average movement distance of the tibia anterior translation was 4.8 ± 1.1 mm, medial proximal tibial angle (MPTA) was 88.9 ± 1.3° at the last follow-up, and the PTS was 8.4 ± 1.4°, both of which were significantly higher than those before surgery (P < 0.05).
CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity. The short-term effect is significant, but the long-term effect requires further follow-up.
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Affiliation(s)
- Fu-Yuan Deng
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang 618000, Sichuan Province, China
| | - Jun-Cai Liu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou 646000, Sichuan Province, China
| | - Zhong Li
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou 646000, Sichuan Province, China
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Barnett SC, Portila G, Sanborn R, Perone GS, Emami A, Kiapour AM. Comparison of Size of Posterior Tibial Slope and Medial Tibial Depth in Patients With an Isolated Meniscal Tear Requiring Surgery and Matched Uninjured Controls. Am J Sports Med 2023; 51:3706-3713. [PMID: 37924211 DOI: 10.1177/03635465231204362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
BACKGROUND Meniscal injuries are extremely common. Several anatomic features of the knee, including the tibial plateau morphology, have been shown to influence knee biomechanics and the risk of ligamentous injuries. Little is known, however, how these morphological features influence the risk of isolated meniscal injuries in the anterior cruciate ligament (ACL)-intact knee. HYPOTHESIS There are differences in the slopes and concavity of the tibial plateau between patients with isolated meniscal tears and matched uninjured controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In total, 89 patients with first-instance isolated medial (n = 37) or lateral (n = 52) meniscal injuries requiring surgical treatment (mean age, 16 ± 1 years; 35% female) were matched to 89 controls with uninjured knees and no previous injuries (mean age, 16 ± 2 years; 35% female) based on age and sex. Magnetic resonance imaging scans (preoperative for injured group) were used to measure the coronal slope of the tibial plateau, posterior slope of the medial and lateral tibial plateaus, and maximum depth of the medial tibial plateau. General linear models were used to evaluate the differences in tibial plateau morphology between the knees with and without meniscal injuries, with and without adjustment for age and sex. RESULTS Compared with matched controls, patients with surgically treated isolated meniscal tears had a smaller lateral tibial slope (by 2.2° [medial meniscal injury] and 1.6° [lateral meniscal injury]; P < .02), a smaller medial tibial slope (by 2.3° [medial meniscal injury] and 2.4° [lateral meniscal injury]; P < .001) and a larger medial tibial depth (by 0.8 mm [medial meniscal injury] and 0.9 mm [lateral meniscal injury]; P < .001). There were no differences in coronal tibial slope between the injured and uninjured groups. There were no differences in quantified anatomic features between the isolated medial and lateral meniscal injury groups. The same trends were observed after adjusting for age and sex. CONCLUSION This study suggests that patients with an isolated meniscal tear requiring surgery have a smaller posterior tibial slope and a larger medial tibial depth (more concave medial tibial plateau) than matched uninjured controls. This is contrary to what is known for ACL tears, in which a steeper posterior tibial slope and a shallower medial tibial depth have been associated with an increased risk of ACL tear.
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Affiliation(s)
- Samuel C Barnett
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriella Portila
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Ryan Sanborn
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabrielle S Perone
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedics, Tufts Medical School, Boston, Massachusetts, USA
| | - Alex Emami
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053-3075. [PMID: 36189967 DOI: 10.1177/03635465221119787] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Med 2023; 53:91-110. [PMID: 36001289 PMCID: PMC9807539 DOI: 10.1007/s40279-022-01747-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. OBJECTIVE The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. METHODS A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. RESULTS Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. CONCLUSION Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
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Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Cruz CA, Mannino BJ, Pike A, Thoma D, Lindell K, Kerbel YE, McCadden A, Lopez AJ, Bottoni CR. Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice. J ISAKOS 2022; 7:100-104. [PMID: 37873691 DOI: 10.1016/j.jisako.2022.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction failure remains a commonly seen complication despite advances in technique and graft options. Recently, several studies have shown that the inclination of the tibial plateau in the sagittal plane affects the stability of the knee joint. The purpose of this study was to determine if an increased posterior slope of the tibia is associated with failure of ACL reconstruction irrespective of the graft used. METHODS From June 2002 to August 2003, a total of 100 patients with a symptomatic ACL-deficient knee were randomised to receive either a hamstring autograft or posterior tibialis allograft. All allografts were from a single tissue bank, aseptically processed, and fresh-frozen without terminal irradiation. ACL graft failures requiring reoperation with a minimum of 10-year follow-up were identified via telephone survey. Lateral radiographs of the knee of all patients were reviewed, and the slope of the tibia was measured using a standardised technique. Two fellowship-trained orthopaedic sports medicine specialists, one board-certified general orthopaedic surgeon, and two fellowship-trained musculoskeletal radiologists measured the tibial slope in all patients. RESULTS At a minimum of 10-year follow-up, there were four (8.3%) autograft and 13 (26.5%) allograft failures that required revision reconstruction. The overall average tibial slope of the nonfailure cohort was 9.4°. The overall average tibial slope of the failure cohort was 11.9° (P = 0.0002). The average slope of the allograft failures was 11.5°compared with an average slope of 9.6° in the nonfailures (P = 0.01). The average slope of the autograft failures was 13.1° compared with 9.3° in the nonfailures (P = 0.011). The mean difference in tibial slope measurements was 0.665 (95% confidence interval: 0.569-0.750). The interrater reliability, as measured by the intraclass correlation coefficient, for tibial slope was 0.898 (95% confidence interval: 0.859-0.928). The Cronbach α was 0.904. CONCLUSION In a prospective, randomised trial of ACL reconstructions using either autograft or allograft, failures were associated with a significantly increased slope of the tibia compared with the nonfailures at 10-year follow-up.
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Affiliation(s)
- Christian A Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
| | - Brian J Mannino
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Andrew Pike
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - David Thoma
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Kenneth Lindell
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Yehuda E Kerbel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin McCadden
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Andrew J Lopez
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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Tanaka T, Gale T, Nishida K, Xu C, Fu F, Anderst W. Posterior tibial slope and meniscal slope correlate with in vivo tibial internal rotation during running and drop jump. Knee Surg Sports Traumatol Arthrosc 2022; 31:2366-2373. [PMID: 36115904 DOI: 10.1007/s00167-022-07163-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between tibial bony and meniscus anatomy and knee kinematics during in vivo, high-impact activities remains unclear. This study aimed to determine if the posterior tibial slope (PTS) and meniscal slope (MS) are associated with in vivo anterior-posterior translation and internal tibia rotation during running and double-leg drop jumps in healthy knees. METHODS Nineteen collegiate athletes performed fast running at 5.0 m/s on an instrumented treadmill and double-leg drop jump from a 60 cm platform while biplane radiographs of the knee were acquired at 150 Hz. Tibiofemoral kinematics were determined using a validated model-based tracking process. Medial and lateral PTS and MS were measured using magnetic resonance imaging (MRI). RESULTS In fast running, more internal tibia rotation was associated with greater PTS (ρ = 0.336, P = 0.039) and MS (ρ = 0.405, P = 0.012) in the medial knee compartment. In the double-leg drop jump, more internal tibia rotation was associated with greater PTS (ρ = 0.431, P = 0.007) and MS (ρ = 0.323, P = 0.005) in the medial knee compartment, as well as a greater PTS in the lateral knee compartment (ρ = 0.445, P = 0.005). CONCLUSION These findings suggest that the medial and lateral PTS and medial MS are associated with the amount of knee rotation during high-impact activities. These in vivo findings improve our understanding of ACL injury risk by linking bone and meniscus morphology to dynamic kinematics.
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Affiliation(s)
- Toshikazu Tanaka
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Kyohei Nishida
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Caiqi Xu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Freddie Fu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.
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Kikuchi N, Kanamori A, Kadone H, Kajiwara M, Okuno K, Hyodo K, Yamazaki M. Relationship Between Posterior Tibial Slope and Lower Extremity Biomechanics During a Single-Leg Drop Landing Combined With a Cognitive Task in Athletes After ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221107931. [PMID: 35837443 PMCID: PMC9274414 DOI: 10.1177/23259671221107931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A steeper posterior tibial slope (PTS) is an important risk factor for
anterior cruciate ligament (ACL) reinjury. The PTS may affect lower
extremity biomechanics under competition-like conditions for athletes with a
reconstructed ACL. Hypothesis: It was hypothesized that the PTS would be associated with lower extremity
biomechanics, which may increase ACL strain. Study Design: Descriptive laboratory study. Methods: Included were 10 athletes (mean age, 20.9 ± 1.8 years) who had undergone ACL
reconstruction. The authors recorded the 3-dimensional lower extremity
biomechanics while participants performed a single-leg drop jump with the
Stroop task (dual task). Kinematic and kinetic data were analyzed and
compared between the involved and contralateral limbs. The medial and
lateral PTSs were measured using magnetic resonance imaging scans of the
involved knee. The correlation between the biomechanical data and the PTS in
each knee was evaluated. Results: The lateral PTS was significantly correlated with the maximum hip adduction
moment (r = 0.64; P < .05) and maximum
internal tibial rotation angle (r = 0.71;
P < .05) in the involved limb. There were no
differences in kinematic and kinetic data between the involved and
contralateral limbs. Conclusion: In athletes after ACL reconstruction, the lateral PTS was directly associated
with the maximum internal tibial rotation angle during single-leg drop
landing with a cognitive task. Clinical Relevance: The findings in this study indicate that a steeper lateral PTS may cause
internal rotation of the tibia during landing, which may be associated with
reinjury in athletes with a reconstructed ACL.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaya Kajiwara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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10
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[Osteotomy close to the knee joint in adults]. DER ORTHOPADE 2022; 51:511-520. [PMID: 35419619 DOI: 10.1007/s00132-022-04250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Osteotomy close to the knee joint in cases of axial deformities or in the context of corrective interventions is still an elementary component of the spectrum of orthopedic surgery. The precise localization and analysis of the pathology are crucial in order to restore approximate physiological loading conditions by means of a suitable osteotomy procedure. Thus, above all, the medial open-wedge tibial osteotomy has become established as a standard procedure for the treatment of knee osteoarthritis caused by extra-articular tibial varus deformity. Furthermore, corrective osteotomy of the sagittal axis of the tibia and of the distal femur also show good long-term results when the indications are correctly interpreted. The osteotomies described in this article are corrections that should be performed after careful consideration of the biological and mechanical aspects. Correct planning, attention to risk factors and the surgical technique are the main factors that determine the long-term success of the procedure.
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11
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Gwinner C, Janosec M, Wierer G, Wagner M, Weiler A. Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope. Am J Sports Med 2021; 49:3802-3808. [PMID: 34672797 PMCID: PMC8649463 DOI: 10.1177/03635465211049234] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased tibial slope (TS) is believed to be a risk factor for anterior cruciate ligament (ACL) tears. Increased TS may also promote graft insufficiency after ACL reconstruction. PURPOSE To delineate the relationship between TS and single as well as multiple graft insufficiencies after ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence 3. METHODS We retrospectively identified 519 patients who had sustained ACL graft insufficiency after primary or revision ACL reconstruction (1 graft insufficiency, group A; 2 graft insufficiencies, group B; and ≥3 graft insufficiencies, group C). In addition, a subgroup analysis was conducted in 63 patients who received all surgical interventions by 2 specialized high-volume, single-center ACL surgeons. TS was measured by an observer with >10 years of training using lateral knee radiographs, and intrarater reliability was performed. Multiple logistic and univariate Cox regression was used to assess the contribution of covariates (TS, age, sex, and bilateral ACL injury) on repeated graft insufficiency and graft survival. RESULTS The study included 347 patients, 119 female and 228 male, who were 24 ± 9 years of age at their first surgery (group A, n = 260; group B, n = 62; group C, n = 25). Mean TS was 9.8°± 2.7° (range, 3°-18°). TS produced the highest adjusted odds ratio (1.73) of all covariates for repeated graft insufficiency. A significant correlation was found between TS and the number of graft insufficiencies (r = 0.48; P < .0001). TS was significantly lower in group A (9.0°± 2.3°) compared with group B (12.1°± 2.5°; P < .0001) and group C (12.0°± 2.6°; P < .0001). A significant correlation was seen between the TS and age at index ACL tear (r = -0.12; P = .02) as well as time to graft insufficiency (r = -0.12; P = .02). A TS ≥12° had an odds ratio of 11.6 for repeated ACL graft insufficiency. CONCLUSION The current results indicate that patients with a markedly increased TS were at risk of early and repeated graft insufficiency after ACL reconstruction. Because the TS is rarely accounted for in primary and revision ACLR, isolated soft tissue procedures only incompletely address recurrent graft insufficiency in this subset of patients.
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Affiliation(s)
- Clemens Gwinner
- Center for Musculoskeletal Surgery,
Charité-University Medicine Berlin, Germany
- Clemens Gwinner, MD, Center
for Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger
Platz 1, Berlin, 13353, Germany (
)
| | - Milan Janosec
- Center for Musculoskeletal Surgery,
Charité-University Medicine Berlin, Germany
| | - Guido Wierer
- Department of Orthopaedics and
Traumatology, Paracelsus Medical University, Salzburg, Austria
- Research Unit for Orthopaedic Sports
Medicine and Injury Prevention, Private University for Health Sciences, Medical
Informatics and Technology, Hall, Austria
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12
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Li W, Liang J, Zeng F, Lin B, Liu C, Huang S, Liu Q. Anatomic characteristics of the knee influence the risk of suffering an isolated meniscal injury and the risk factors differ between women and men. Knee Surg Sports Traumatol Arthrosc 2021; 29:3751-3762. [PMID: 33388828 DOI: 10.1007/s00167-020-06396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyse the relationship between multiple anatomic characteristics of the knee (tibia and femur) and isolated meniscal injury in women and men. METHODS Forty-seven patients with isolated medial meniscal injuries, 62 patients with isolated lateral meniscal injuries, and 70 control subjects were included. Medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), medial tibial plateau depth (MTD), coronal tibial slope (CTS), femoral notch width (NW), femoral condylar width (FCW), intercondylar notch depth (ND), femoral notch width index (NWI), intercondylar notch shape index (NSI), and cruciate ligaments tensity (CLT) were measured from magnetic resonance images. Anatomic characteristics differing between groups were compared, and risk factors for isolated meniscal injury were identified by multivariate forward stepwise logistic regression for men and women separately. RESULTS Risk factors for an isolated medial meniscal injury were a steeper MTS and a lowered MTD in men, and a steeper MTS and an increased NWI in women. Risk factors for isolated lateral meniscal injury were a steeper LTS and an increased NW in men, and a steeper LTS and a lowered ND in women. Risk factors for both medial and lateral meniscal injuries were a higher CTS, an increased NWI, and a looser CLT in men, and a higher CTS, an increased NSI, and a looser CLT in women. CONCLUSION The anatomic characteristics of the tibial plateau, femur, and cruciate ligaments influence the risk of suffering isolated meniscal injury, and the risk factors differ between men and women. This study provides a reference for developing identification criteria for those at risk of isolated meniscal injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wenhua Li
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Jie Liang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Fei Zeng
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Bomiao Lin
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Chenglong Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China.
| | - Shijia Huang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Qiaolan Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
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13
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Gao KT, Pedoia V, Young KA, Kogan F, Koff MF, Gold GE, Potter HG, Majumdar S. Multiparametric MRI characterization of knee articular cartilage and subchondral bone shape in collegiate basketball players. J Orthop Res 2021; 39:1512-1522. [PMID: 32910520 PMCID: PMC8359246 DOI: 10.1002/jor.24851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) is commonly used to evaluate the morphology of the knee in athletes with high-knee impact; however, complex repeated loading of the joint can lead to biochemical and structural degeneration that occurs before visible morphological changes. In this study, we utilized multiparametric quantitative MRI to compare morphology and composition of articular cartilage and subchondral bone shape between young athletes with high-knee impact (basketball players; n = 40) and non-knee impact (swimmers; n = 25). We implemented voxel-based relaxometry to register all cases to a single reference space and performed a localized compositional analysis of T 1ρ - and T 2 -relaxation times on a voxel-by-voxel basis. Additionally, statistical shape modeling was employed to extract differences in subchondral bone shape between the two groups. Evaluation of cartilage composition demonstrated a significant prolongation of relaxation times in the medial femoral and tibial compartments and in the posterolateral femur of basketball players in comparison to relaxation times in the same cartilage compartments of swimmers. The compositional analysis also showed depth-dependent differences with prolongation of the superficial layer in basketball players. For subchondral bone shape, three total modes were found to be significantly different between groups and related to the relative sizes of the tibial plateaus, intercondylar eminences, and the curvature and concavity of the patellar lateral facet. In summary, this study identified several characteristics associated with a high-knee impact which may expand our understanding of local degenerative patterns in this population.
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Affiliation(s)
- Kenneth T. Gao
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Valentina Pedoia
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Feliks Kogan
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Matthew F. Koff
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Garry E. Gold
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Hollis G. Potter
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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14
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Weiler A, Dickschas J, Gwinner C. Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results. J Knee Surg 2021; 34:592-598. [PMID: 33618406 DOI: 10.1055/s-0041-1723983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2-5 degrees) was increased to a mean of 11.5 degrees (range = 9-13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.
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Affiliation(s)
| | - Jörg Dickschas
- Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Germany
| | - Clemens Gwinner
- Center for Musculoskelettal Surgery, Charité University Medicine, Berlin, Germany
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15
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Kaplan JT, Ramsay JW, Cameron SE, Seymore KD, Brehler M, Thawait GK, Zbijewski WB, Siewerdsen JH, Brown TN. Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load. Am J Sports Med 2020; 48:1389-1397. [PMID: 32255657 DOI: 10.1177/0363546520911608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a military occupational hazard that may be attributed to an individual's knee biomechanics and joint anatomy. This study sought to determine if greater flexion when landing with load resulted in knee biomechanics thought to decrease ACL injury risk and whether knee biomechanics during landing relate to knee anatomic metrics. HYPOTHESIS Anatomic metrics regarding the slope and concavity of the tibial plateau will exhibit a significant relation to the increased anterior shear force on the knee and decreased knee flexion posture during landing with body-borne load. STUDY DESIGN Descriptive laboratory study. METHODS Twenty male military personnel completed a drop landing task with 3 load conditions: light (~6 kg), medium (15% body weight), and heavy (30% body weight). Participants were divided into groups based on knee flexion exhibited when landing with the heavy load (high- and low-Δflexion). Tibial slopes and depth were measured on weightbearing volumetric images of the knee obtained with a prototype cone beam computed tomography system. Knee biomechanics were submitted to a linear mixed model to evaluate the effect of landing group and load, with the anatomic metrics considered covariates. RESULTS Load increased peak proximal anterior tibial shear force (P = .034), knee flexion angle (P = .024), and moment (P = .001) during landing. Only the high flexion group increased knee flexion (P < .001) during weighted landings with medium and heavy loads. The low flexion group used greater knee abduction angle (P = .030) and peak proximal anterior tibial shear force (P = .034) when landing with load. Anatomic metrics did not differ between groups, but ratio of medial-to-lateral tibial slope and medial tibial depth predicted peak proximal anterior tibial shear force (P = .009) and knee flexion (P = .034) during landing, respectively. CONCLUSION Increasing knee flexion is an attainable strategy to mitigate risk of ACL injury, but certain individuals may be predisposed to knee forces and biomechanics that load the ACL during weighted landings. CLINICAL RELEVANCE The ability to screen individuals for anatomic metrics that predict knee flexion may identify soldiers and athletes who require additional training to mitigate the risk of lower extremity injury.
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Affiliation(s)
- Jonathan T Kaplan
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | - John W Ramsay
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | | | - Kayla D Seymore
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
| | - Michael Brehler
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gaurav K Thawait
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wojciech B Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey H Siewerdsen
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tyler N Brown
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
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16
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Sauer S, English R, Clatworthy M. The influence of tibial slope on anterior cruciate ligament graft failure risk is dependent on graft positioning. J Orthop Surg (Hong Kong) 2020; 27:2309499019834674. [PMID: 30852943 DOI: 10.1177/2309499019834674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Increased lateral tibial posterior slope (LTPS) is associated with higher anterior cruciate ligament (ACL) reconstruction (ACLR) failure rate. Transportal central femoral footprint ACLR is associated with higher failure rate compared to transtibial high anteromedial footprint ACLR due to graft anisometry. The purpose of this study was to investigate whether the influence of tibial slope on ACL graft failure risk is dependent on graft positioning. MATERIAL Of the 1480 consecutive hamstring ACLRs, 30 transportal (central femoral tunnel placement) and 30 transtibial (high anteromedial tunnel placement) ACLR failures were evaluated and matched one-to-one with non-failure control participants by age, sex, graft and surgical technique. Lateral tibial slope was assessed on MRI. RESULTS The risk of graft failure in the transportal group increased by 40.5% per degree of increasing LTPS (odds ratio 1.4; 95% confidence interval 1.05-1.87; p = 0.02). The transportal failure group showed a significantly higher mean tibial slope of 8.6° compared to both the transportal control group with 7.1° ( p = 0.03) and the transtibial failure group with 7.2° ( p = 0.04). Increased tibial slope was associated with shorter time to reconstruction failure ( p = 0.002). The difference between slopes in the transtibial failure group (7.2°) compared to the transtibial control group (7.1°) was not significant ( p = 0.56). CONCLUSION Increased LTPS is associated with significantly increased risk of graft failure only in transportal ACLR, not in transtibial ACLR. Slope-related graft strain may be potentiated by anisometric ACL graft placement.
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17
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Kızılgöz V, Sivrioğlu AK, Aydın H, Ulusoy GR, Çetin T, Tuncer K. The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119867922. [PMID: 31427857 PMCID: PMC6681250 DOI: 10.1177/1179544119867922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of
anterior cruciate ligament (ACL) injury in the literature. A higher body
mass index (BMI) might increase the risk of ACL tear because of greater
axial compressive force. The aim of this study was to determine the
relationship of these factors and the combined effect of BMI and TSA in
determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees
and of 68 male individuals with no ACL injuries were evaluated by 2
radiologists to measure the TSA. The Mann-Whitney U-test
was performed to indicate the significant difference in height, weight, and
BMI values. The independent samples t-test was used to
determine the differences between ACL-injured and non-injured groups
regarding TSA values. Odds ratios were calculated by logistic regression
tests, and receiver operating characteristics (ROC) curves revealed the area
under the receiver operating characteristics curve (AUC) values to compare
the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS)
were predictive of ACL risk injury. Body mass index alone had the greatest
effect among these parameters, and there were no statistically significant
differences in coronal tibial slope values between the ACL-ruptured and
control groups. The greatest AUC was observed for the combination of BMI,
MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and
BMI + MTS + LTS together revealed the greatest effect on ACL injury.
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Affiliation(s)
- Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ali Kemal Sivrioğlu
- Department of Radiology, Faculty of Medicine, Kocaeli University, Izmit, Turkey
| | - Hasan Aydın
- Department of Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gökhan Ragıp Ulusoy
- Department of Orthopaedics, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Türkhun Çetin
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kutsi Tuncer
- Department of Orthopaedics, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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18
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Kolbe R, Schmidt-Hebbel A, Forkel P, Pogorzelski J, Imhoff AB, Feucht MJ. Steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant posterolateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2019; 27:2585-2591. [PMID: 30390134 DOI: 10.1007/s00167-018-5279-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE To compare sagittal and coronal tibial slopes between anterior cruciate ligament (ACL) injured subjects with and without posterolateral meniscus root tear (PLRT). METHODS A chart review was conducted to identify patients with isolated ACL tears and patients with an associated PLRT. Patients with other concomitant injuries and patients who underwent surgery > 6 months after the injury were excluded. Magnetic resonance image data were used to compare the medial and lateral sagittal tibial slope (MTS and LTS), lateral-to-medial slope asymmetry (LTS-MTS), and coronal slope of the tibial plateau between both groups. Mean LTS and standard deviation (SD) of the control group were calculated, and a value of > mean + 1 SD was considered an abnormal LTS. Interobserver reproducibility was assessed by calculating interclass correlation coefficients (ICCs) of measurements independently obtained by two reviewers. RESULTS Fifty-nine patients met the in- and exclusion criteria. Thirty nine (66%) had an isolated ACL tear and 20 (34%) had an associated PLRT. Interrater ICCs for LTS, MTS, and coronal slope were 0.930, 0.884 and 0.825, respectively, representing good to excellent interobserver reproducibility. Patients with a PLRT had significantly steeper LTS (8.0 ± 3.2 vs. 4.0 ± 2.0; p < 0.001) and significantly greater difference of LTS-MTS (3.7 ± 2.9 vs. - 0.6 ± 2.0; p < 0.001). Furthermore, patients with abnormal LTS were significantly overrepresented among patients with PLRT (70% vs. 18%; p < 0.001). No significant difference between both groups was found for MTS and coronal slope. CONCLUSION A steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant PLRT in ACL-injured subjects. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Rainer Kolbe
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrés Schmidt-Hebbel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jonas Pogorzelski
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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20
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Kiapour AM, Yang DS, Badger GJ, Karamchedu NP, Murray MM, Fadale PD, Hulstyn MJ, Shalvoy RM, Fleming BC. Anatomic Features of the Tibial Plateau Predict Outcomes of ACL Reconstruction Within 7 Years After Surgery. Am J Sports Med 2019; 47:303-311. [PMID: 30640519 PMCID: PMC6382545 DOI: 10.1177/0363546518823556] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple anatomic features of the femoral condyles and tibial plateau have been shown to influence knee biomechanics and risk of anterior cruciate ligament (ACL) injury. However, it remains unclear how these anatomic factors affect the midterm outcomes of ACL reconstruction. HYPOTHESIS Decreased femoral notch width, increased posterior and coronal slopes, and decreased concavity of the tibial plateau are associated with inferior clinical, patient-reported, and osteoarthritis-related outcomes 7 years after ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Prospectively collected data from 44 patients who did not have a subsequent graft or contralateral ACL failure within 7 years after unilateral ACL reconstruction were reviewed (mean ± SD age, 23.7 ± 9.2 years; 64% women). Notch width (after notchplasty), posterior slopes of the medial and lateral tibial plateau, maximum depth of the medial tibial plateau, and coronal tibial slope were measured from magnetic resonance images. Anatomic predictors of side-to-side differences in anterior-posterior knee laxity, Knee injury and Osteoarthritis Outcome Score (KOOS), medial joint space width, and side-to-side differences in Osteoarthritis Research Society International (OARSI) x-ray score, measured at 7 years, were identified with linear regression (bivariate) and stepwise regression (multivariate). RESULTS Increased posterior slope of the lateral tibial plateau was associated with increased side-to-side difference in knee laxity (bivariate model only), increased side-to-side difference in the OARSI score, and decreased KOOS subscores ( R2 > .10, P < .05). Increased posterior slope of the medial tibial plateau was associated with a higher side-to-side difference in the OARSI x-ray score (bivariate model only) and lower KOOS subscores ( R2 > .11, P < .03). Increased coronal tibial slope was associated with lower KOOS subscores ( R2 > .11, P < .03). Decreased medial tibial depth was associated with increased knee laxity as well as decreased KOOS subscores (ie, quality of life and symptoms; R2 > .12, P < .03). Postoperative notch width was not a significant predictor for any surgical outcome. None of the anatomic features were predictive of medial joint space width narrowing. CONCLUSION Results partially support the hypothesis and highlight the importance of knee anatomy on several outcomes of ACL reconstruction among patients without subsequent graft or contralateral ACL injures. Increasing slopes in the coronal and sagittal planes with decreasing concavity of the medial tibial plateau lead to less favorable outcomes 7 years after surgery.
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Affiliation(s)
- Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA
| | - Daniel S. Yang
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA
| | - Paul D. Fadale
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Michael J. Hulstyn
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Robert M. Shalvoy
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI,School of Engineering, Brown University, Providence, RI
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21
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Bates NA, Mejia Jaramillo MC, Vargas M, McPherson AL, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings. Clin Biomech (Bristol, Avon) 2019; 61:84-94. [PMID: 30530064 PMCID: PMC6448403 DOI: 10.1016/j.clinbiomech.2018.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the relationship between tibial slope angle and ligament strain during in vitro landing simulations that induce ACL failure through the application of variable external loading at the knee. The hypothesis tested was that steeper posterior tibial slope angle would be associated with higher ACL strain during a simulated landing task across all external loading conditions. METHODS Kinetics previously derived from an in vivo cohort performing drop landings were reproduced on 45 cadaveric knees via the mechanical impact simulator. MRIs were taken of each specimen and used to calculate medial compartment posterior tibial slope, lateral compartment posterior tibial slope, and coronal plane tibial slope. Linear regression analyses were performed between these angles and ACL strain to determine whether tibial slope was a predictive factor for ACL strain. FINDINGS Medial and lateral posterior tibial slope were predictive factors for ACL strain during some landings with higher combined loads. Medial posterior slope was more predictive of ACL strain in most landings for male specimens, while lateral posterior and coronal slope were more predictive in female specimens, but primarily when high abduction moments were applied. INTERPRETATION Tibial slope has the potential to influence ACL strain during landing, especially when large abduction moments are present at the knee. Deleterious external loads to the ACL increase the correlation between tibial slope and ACL strain, which indicates that tibial slope angles are an additive factor for athletes apt to generate large out-of-plane knee moments during landing tasks.
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Affiliation(s)
- Nathaniel A Bates
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
| | | | - Manuela Vargas
- Department of Biomedical Engineering, Universidad EIA, Medellin, Colombia
| | - April L McPherson
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Schilaty
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron J Krych
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
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22
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Jaecker V, Drouven S, Naendrup JH, Kanakamedala AC, Pfeiffer T, Shafizadeh S. Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction. Arch Orthop Trauma Surg 2018; 138:1423-1431. [PMID: 29808437 DOI: 10.1007/s00402-018-2968-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To analyze the contribution of increased lateral (LTPS) and medial tibial slopes (MTPS) as independent risk factors of graft failure following anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS Fifty-seven patients with graft failure after ACL reconstruction who underwent revision surgery between 2009 and 2014 were enrolled and matched to a control group of 69 patients with primary anatomic successful ACL reconstruction. Patients were matched based on age, sex, date of primary surgery and graft type. LTPS and MTPS were measured on MRI in a blinded fashion. Tibial and femoral tunnel positions were determined on CT scans. Independent t test was used to compare the MTPS and LTPS between subgroups. Risks of graft failure associated with an increasing MTPS and LTPS were analyzed using binary logistic analysis. RESULTS The means of LTPS (7.3°) and MTPS (6.7°) in the graft failure group were found to be significantly greater than in the control group (4.6° and 4.1°, respectively; p = < 0.001). Non-anatomic and anatomic tunnel positions were found in 42 cases (73.7%) and 15 cases (26.3%), respectively. There were no significant differences in MTPS or LTPS between patients with anatomic and non-anatomic tunnel positions within the graft failure group. An increase of the MTPS of 1° was associated with an 1.24 times increased likelihood of exhibiting graft failure [95% CI 1.07-1.43] (p = 0.003) and an increase of the LTPS of 1° was associated with an 1.17 times increased likelihood of exhibiting graft failure [95% CI 1.04-1.31] (p = 0.009). The increased risk was most evident in patients with a lateral tibial posterior slope of ≥ 10°. CONCLUSIONS Increased LTPS and MTPS are independent risk factors for graft failure following ACL reconstruction regardless whether tunnel position is anatomic or non-anatomic. This information may be helpful to clinicians when considering slope correction in selected revision ACL reconstruction procedures.
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Affiliation(s)
- Vera Jaecker
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sabrina Drouven
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Ajay C Kanakamedala
- University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Thomas Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sven Shafizadeh
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
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23
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Sauer S, English R, Clatworthy M. The Ratio of Tibial Slope and Meniscal Bone Angle for the Prediction of ACL Reconstruction Failure Risk. Surg J (N Y) 2018; 4:e152-e159. [PMID: 30131976 PMCID: PMC6102115 DOI: 10.1055/s-0038-1668111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022] Open
Abstract
Background A growing body of research is indicating that the tibial slope and the geometry of the tibiofemoral meniscal-cartilage interface may affect the risk of anterior cruciate ligament reconstruction (ACLR) failure. Increased lateral tibial posterior slope (LTPS) and reduced meniscal bone angle (MBA) are associated with increased risk of anterior cruciate ligament (ACL) injury. The significance of a LTPS-MBA ratio regarding the prediction of ACL failure risk remains unknown. As LTPS and MBA may eventually potentiate or neutralize each other, it is expected that a low LTPS-MBA ratio is associated with high chance of ACL graft survival while a high LTPS-MBA ratio is associated with high risk of ACL failure. Material and Methods Out of 1,487 consecutive patients who underwent hamstring ACLR between August 2000 and May 2013, 54 ACLR failures with intact lateral menisci were included in this study and matched one-to-one with 54 control participants by age, sex, graft, surgical technique, and graft fixation method. Control participants had undergone ACLR without signs of lateral meniscal injury, graft failure, or insufficiency. MBA and LTPS were assessed on magnetic resonance imaging. Logistic regression was used to identify LTPS/MBA key cut-off ratios. Results In this cohort, a LTPS-MBA ratio under 0.27 was associated with a 28% risk of ACLR failure (36% of patients), while a ratio exceeding 0.42 was associated with an 82% risk of ACLR failure (31% of patients). The odds of ACL failure increased by 22.3% per reduction of 1 degree in MBA (odds ratio [OR], 1.22; 95% limits, 1.1-1.34). No significant association was found between LTPS and the risk of ACL graft failure in transtibial ACLR, while the odds of ACL failure increased by 34.9% per degree of increasing LTPS in transportal ACLR (OR, 1.34; 95% limits, 1.01-1.79). No significant correlation was found between MBA and LTPS ( p = 0.5). Conclusion Reduced MBA was associated with significantly increased risk of ACL graft failure. A ratio of LTPS and MBA was found to be useful for the prediction of ACLR failure risk and may preoperatively help to identify patients at high risk of ACLR failure. This may have implications for patient counseling and the indication of additional extra-articular stabilizing procedures.
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Affiliation(s)
- Steffen Sauer
- Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert English
- Department of Orthopaedic Surgery, Middlemore Hospital, The University of Auckland, Auckland, New Zealand
| | - Mark Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, The University of Auckland, Auckland, New Zealand
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24
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Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA. 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope. Am J Sports Med 2018; 46:531-543. [PMID: 29244525 DOI: 10.1177/0363546517741497] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. PURPOSE To compare the prospective longitudinal outcome of "isolated" ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). RESULTS At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. CONCLUSION Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.
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Affiliation(s)
- Lucy J Salmon
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Emma Heath
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Hawar Akrawi
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Justin P Roe
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | | | - Leo A Pinczewski
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia.,University of Notre Dame, South Bend, Indiana, USA
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25
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Cavaignac E, Perroncel G, Thépaut M, Vial J, Accadbled F, De Gauzy JS. Relationship between tibial spine size and the occurrence of osteochondritis dissecans: an argument in favour of the impingement theory. Knee Surg Sports Traumatol Arthrosc 2017; 25:2442-2446. [PMID: 26658568 DOI: 10.1007/s00167-015-3907-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/26/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Pathophysiology of osteochondritis dissecans (OCD) of the medial femoral condyle remains uncertain. Specifically, the relationship between the size of the anterior tibial spine (ATS) and the presence of OCD has not been explored. The purpose of this study was to evaluate the relationship between ATS size and the occurrence of OCD. METHODS Seventy-nine children between 8 and 17 years of age were included in two groups: OCD (n = 37) and control (n = 42). The groups were matched in terms of age, gender, BMI and weight. Two independent observers performed an MRI analysis of the size of the tibial spine and intercondylar notch relative to the size of the respective epiphyses. For this study, the "S ratio" was calculated by dividing the height of the tibial spine by the height of the tibial epiphysis. The "N ratio" was calculated by dividing the height of the notch by the height of the femoral epiphysis. These two ratios for both groups were compared using Student's t test. RESULTS The mean value of the S ratio in the OCD group was 0.39 ± 0.06; the mean value of the S ratio in the control group was 0.32 ± 0.03 (P = 0.004). The mean value of the N ratio in the OCD group was 0.70 ± 0.08; the mean value of the N ratio in the control group was 0.70 ± 0.07 (n.s.). CONCLUSION This study's findings confirm our hypothesis that patients with OCD have a more prominent tibial spine than in patients without OCD. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 1 place Baylac, 31000, Toulouse, France.
| | - Geoffroy Perroncel
- Pediatric Radiology Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Mathias Thépaut
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Julie Vial
- Pediatric Radiology Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Franck Accadbled
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Jérôme Sales De Gauzy
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
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26
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Wang YL, Yang T, Zeng C, Wei J, Xie DX, Yang YH, Long HZ, Xu B, Qian YX, Jiang SD, Lei GH. Association Between Tibial Plateau Slopes and Anterior Cruciate Ligament Injury: A Meta-analysis. Arthroscopy 2017; 33:1248-1259.e4. [PMID: 28302427 DOI: 10.1016/j.arthro.2017.01.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the associations of medial tibial plateau slope (MTPS), lateral tibial plateau slope (LTPS), and coronal tibial plateau slope (CTPS) with anterior cruciate ligament (ACL) injury both in the general population and in different gender subgroups. METHODS PubMed, Ovid, Embase, and Scopus databases were searched through from inception to August 31, 2016. Observational studies reporting associations of MTPS/LTPS/CTPS with ACL injury were retrieved for analysis. Either a fixed- or random-effects model was used to calculate the overall standardized mean difference (SMD). Reviews, meeting abstracts, cadaver or animal studies, and other studies without disclosing full text were excluded in this study. RESULTS A total of 29 studies were included. Subjects with ACL injury exhibited a significant increase in MTPS (SMD: 0.34 [95% confidence interval (CI): 0.18, 0.49]; P < .0001) and LTPS (SMD: 0.49 [95% CI: 0.30, 0.68]; P < .00001), but not in the CTPS (SMD: 0.09 [95% CI: -0.10, 0.27]; P = .36), compared with controls. Meanwhile, significant differences in MTPS and LTPS were observed in the male subgroup (SMD: 0.41 [95% CI: 0.20, 0.62]; P = .0001 and SMD: 0.55 [95% CI: 0.26, 0.85]; P = .0002, respectively) but not in the female (SMD: 0.31 [95% CI: -0.02, 0.64]; P = .06 and SMD: 0.26 [95% CI: -0.04, 0.56]; P = .09, respectively). CONCLUSIONS The present meta-analysis showed that the increases in MTPS and LTPS were overall risk factors of ACL injury. However, these slopes would only be considered as "at risk" for males, but not for females. In addition, it was also proved that CTPS was not a risk factor of ACL injury. LEVEL OF EVIDENCE Level III, meta-analysis of Level II and III studies.
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Affiliation(s)
- Yi-Lun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Dong-Xing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuan-Heng Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Hui-Zhong Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Bei Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yu-Xuan Qian
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Shi-de Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Guang-Hua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Center for Clinical Technology and Research of Joint Surgery of Hunan Province, Changsha, Hunan Province, China.
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27
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Sundar S, Patnaik S, Ubaydullaev B, Kolandavelu V, Rajan D. Tibial plateau slopes in Indian patients with or without anterior cruciate ligament injury: a magnetic resonance imaging study. J Orthop Surg (Hong Kong) 2016; 24:289-293. [PMID: 28031492 DOI: 10.1177/1602400303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To compare anterior cruciate ligament (ACL)-injured and ACL-intact patients as well as males and females in terms of tibial plateau slopes to determine their association with ACL injury. METHODS Magnetic resonance images (MRI) of the knee of 310 male and 179 female skeletally mature Indian patients (mean age, 40 years) with (n=170+29) or without (n=140+150) ACL injury were reviewed. Their medial and lateral tibial plateau slopes (MTPS and LTPS), medial tibial plateau depth (MTPD), and lateral tibial plateau height (LTPH) were measured using MRI. RESULTS The ACL-injured and ACL-intact groups were comparable in terms of MTPS (6.72º vs. 6.73º, p=0.07), LTPS (5.68º vs. 5.70º, p=0.09), MTD (1.74 vs. 1.73 mm, p=0.356), and LTH (2.21 vs. 2.22 mm, p=0.393). Males and females were also comparable in terms of MTPS and LTPS in both ACL-injured and ACL-intact groups. CONCLUSION ACL-injured and ACL-intact patients as well as males and females were comparable in terms of the tibial plateau slope parameters.
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Affiliation(s)
- Shyam Sundar
- Ortho One Orthopaedic Specialty Centre, Coimbatore, Tamilnadu, India
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28
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Shimokochi Y, Ambegaonkar JP, Meyer EG. Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia. J Athl Train 2016; 51:669-681. [PMID: 27723362 DOI: 10.4085/1062-6050-51.10.15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown. OBJECTIVE To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty recreationally active participants (age = 23.4 ± 3.6 years, height = 171.0 ± 9.4 cm, mass = 73.3 ± 12.7 kg). INTERVENTION(S) Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded. MAIN OUTCOME MEASURE(S) Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces. RESULTS The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles. CONCLUSIONS Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of single-legged landing. Therefore, improving sagittal-plane landing mechanics is important in reducing harmful magnitudes and directions of impact forces on the anterior cruciate ligament.
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Affiliation(s)
- Yohei Shimokochi
- Sport Medicine and Science Research Laboratory, Department of Health and Sport Management, Osaka University of Health and Sport Sciences, Japan
| | - Jatin P Ambegaonkar
- Sports Medicine Assessment Research and Testing Laboratory, George Mason University, Manassas, VA
| | - Eric G Meyer
- Experimental Biomechanics Laboratory, Lawrence Technological University, Southfield, MI
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29
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Cronström A, Creaby MW, Nae J, Ageberg E. Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis. Gait Posture 2016; 49:315-328. [PMID: 27479217 DOI: 10.1016/j.gaitpost.2016.07.107] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive. OBJECTIVE To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury. METHODS A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; -1.34, 95%CI; -1.83 to -0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; -0.68 to -0.79, 95%CI; -1.04 to -0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis. CONCLUSION The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia.
| | - Jenny Nae
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden.
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30
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Driban JB, Stout AC, Duryea J, Lo GH, Harvey WF, Price LL, Ward RJ, Eaton CB, Barbe MF, Lu B, McAlindon TE. Coronal tibial slope is associated with accelerated knee osteoarthritis: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord 2016; 17:299. [PMID: 27432004 PMCID: PMC4950083 DOI: 10.1186/s12891-016-1158-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/03/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Accelerated knee osteoarthritis may be a unique subset of knee osteoarthritis, which is associated with greater knee pain and disability. Identifying risk factors for accelerated knee osteoarthritis is vital to recognizing people who will develop accelerated knee osteoarthritis and initiating early interventions. The geometry of an articular surface (e.g., coronal tibial slope), which is a determinant of altered joint biomechanics, may be an important risk factor for incident accelerated knee osteoarthritis. We aimed to determine if baseline coronal tibial slope is associated with incident accelerated knee osteoarthritis or common knee osteoarthritis. METHODS We conducted a case-control study using data and images from baseline and the first 4 years of follow-up in the Osteoarthritis Initiative. We included three groups: 1) individuals with incident accelerated knee osteoarthritis, 2) individuals with common knee osteoarthritis progression, and 3) a control group with no knee osteoarthritis at any time. We did 1:1:1 matching for the 3 groups based on sex. Weight-bearing, fixed flexion posterior-anterior knee radiographs were obtained at each visit. One reader manually measured baseline coronal tibial slope on the radiographs. Baseline femorotibial angle was measured on the radiographs using a semi-automated program. To assess the relationship between slope (predictor) and incident accelerated knee osteoarthritis or common knee osteoarthritis (outcomes) compared with no knee osteoarthritis (reference outcome), we performed multinomial logistic regression analyses adjusted for sex. RESULTS The mean baseline slope for incident accelerated knee osteoarthritis, common knee osteoarthritis, and no knee osteoarthritis were 3.1(2.0), 2.7(2.1), and 2.6(1.9); respectively. A greater slope was associated with an increased risk of incident accelerated knee osteoarthritis (OR = 1.15 per degree, 95 % CI = 1.01 to 1.32) but not common knee osteoarthritis (OR = 1.04, 95 % CI = 0.91 to 1.19). These findings were similar when adjusted for recent injury. Among knees with varus malalignment a greater slope increases the odds of incident accelerated knee osteoarthritis; there is no significant relationship between slope and incident accelerated knee osteoarthritis among knees with normal alignment. CONCLUSIONS Coronal tibial slope, particularly among knees with malalignment, may be an important risk factor for incident accelerated knee osteoarthritis.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
| | - Alina C Stout
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA
| | - William F Harvey
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA.,Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box #63, Boston, MA, 02111, USA
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, 800 Washington Street, Box #299, Boston, MA, 02111, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, 111 Brewster St, Pawtucket, RI, 02860, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Bing Lu
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
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Wang HM, Shultz SJ, Schmitz RJ. Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity. J Athl Train 2016; 51:460-5. [PMID: 27356008 DOI: 10.4085/1062-6050-51.7.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. OBJECTIVE To determine the relationship of ACL width and femoral notch angle to AKL. DESIGN Cross-sectional study. SETTING Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). MAIN OUTCOME MEASURE(S) Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. RESULTS Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R(2) = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. CONCLUSIONS A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.
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Affiliation(s)
- Hsin-Min Wang
- Department of Sports Medicine, China Medical University, Taiwan
| | - Sandra J Shultz
- Department of Kinesiology, Applied Neuromechanics Research Laboratory, The University of North Carolina at Greensboro
| | - Randy J Schmitz
- Department of Kinesiology, Applied Neuromechanics Research Laboratory, The University of North Carolina at Greensboro
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32
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Tran AA, Gatewood C, Harris AHS, Thompson JA, Dragoo JL. The effect of foot landing position on biomechanical risk factors associated with anterior cruciate ligament injury. J Exp Orthop 2016; 3:13. [PMID: 27315816 PMCID: PMC4912543 DOI: 10.1186/s40634-016-0049-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identification of biomechanical risk factors associated with anterior cruciate ligament (ACL) injury can facilitate injury prevention. The purpose of this study is to investigate the effects of three foot landing positions, "toe-in", "toe-out" and "neutral", on biomechanical risk factors for ACL injury in males and females. The authors hypothesize that 1) relative to neutral, the toe-in position increases the biomechanical risk factors for ACL injury, 2) the toe-out position decreases these biomechanical risk factors, and 3) compared to males, females demonstrate greater changes in lower extremity biomechanics with changes in foot landing position. METHODS Motion capture data on ten male and ten female volunteers aged 20-30 years (26.4 ± 2.50) were collected during double-leg jump landing activities. Subjects were asked to land on force plates and target one of three pre-templated foot landing positions: 0° ("neutral"), 30° internal rotation ("toe-in"), and 30° external rotation ("toe-out") along the axis of the anatomical sagittal plane. A mixed-effects ANOVA and pairwise Tukey post-hoc comparison were used to detect differences in kinematic and kinetic variables associated with biomechanical risk factors of ACL injury between the three foot landing positions. RESULTS Relative to neutral, landing in the toe-in position increased peak hip adduction, knee internal rotation angles and moments (p < 0.01), and peak knee abduction angle (p < 0.001). Landing in the toe-in position also decreased peak hip flexion angle (p < 0.001) and knee flexion angle (p = 0.023). Landing in the toe-out position decreased peak hip adduction, knee abduction, and knee internal rotation angles (all p < 0.001). Male sex was associated with a smaller increase in hip adduction moment (p = 0.043) and knee internal rotation moment (p = 0.032) with toe-in landing position compared with female sex. CONCLUSIONS Toe-in landing position exacerbates biomechanical risk factors associated with ACL injury, while toe-out landing position decreases these factors.
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Affiliation(s)
- Andrew A Tran
- Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.,Human Performance Lab, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA
| | - Corey Gatewood
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.,Human Performance Lab, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA
| | - Alex H S Harris
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Julie A Thompson
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.,Department of Bioengineering, Stanford University, Stanford, CA, USA.,Human Performance Lab, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA
| | - Jason L Dragoo
- Stanford University School of Medicine, Stanford University, Stanford, CA, USA. .,Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA. .,Human Performance Lab, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA.
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33
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Wechter JF, Sikka RS, Alwan M, Nelson BJ, Tompkins M. Proximal tibial morphology and its correlation with osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3717-22. [PMID: 25248309 DOI: 10.1007/s00167-014-3289-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/28/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE The relationship of proximal tibial morphology to the presence of femoral osteochondritis dissecans (OCD) lesions is unknown. This radiographic study tested the null hypothesis that knees with unilateral medial or lateral OCD lesions would have no difference in the slope of their medial, lateral, or posterior tibial plateau compared with unaffected knees. METHODS There were 72 patients with unilateral OCD lesions of the medial or lateral femoral condyle seen at our institution from 2005 to 2011. On AP and lateral radiographs of the knee, three examiners conducted independent measurements of the tibial plateau posterior slope, as well as medial and lateral slope as measured from the peak of the tibial spine to the edge of the plateau on the side of the corresponding OCD lesion. Measurements were repeated on normal contralateral and matched control knees. RESULTS Knees with medial femoral condyle OCD lesions had greater medial tibial slope compared with normal contralateral knees (p = 0.007) and normal controls (p < 0.04). Knees with lateral femoral condyle OCD lesions had no significant difference in lateral tibial slope compared with the contralateral knee or matched controls. Posterior slope was greater in knees with medial OCD lesions than matched controls (p = 0.007). Intraclass correlation coefficients demonstrated consistency between observers for all measurements. CONCLUSION An assessment of proximal tibial morphology demonstrated greater medial and posterior tibial slope in knees with medial OCD lesions compared with normal knees. The technique for measuring medial and lateral tibial slope was reliable among evaluators. The clinical relevance is that proximal tibial morphology may have a relationship with OCD lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John F Wechter
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.
| | - Robby Singh Sikka
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Mujtaba Alwan
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA
| | - Bradley J Nelson
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
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34
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Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research Retreat VII: An Update on Anterior Cruciate Ligament Injury Risk Factor Identification, Screening, and Prevention. J Athl Train 2015; 50:1076-93. [PMID: 26340613 PMCID: PMC4641546 DOI: 10.4085/1062-6050-50.10.06] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Anne Benjaminse
- The Department of Human Movement Sciences, University of Groningen, and The School of Sports Studies, Hanze University, Groningen, The Netherlands
| | - Malcolm Collins
- Department of Human Biology, University of Cape Town, South Africa
| | - Kevin Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Anthony S. Kulas
- Department of Health Education and Promotion, Eastern Carolina University, Greenville, NC
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35
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Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS, Dahm DL. Lateral Tibial Posterior Slope Is Increased in Patients With Early Graft Failure After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2015; 43:2510-4. [PMID: 26320223 DOI: 10.1177/0363546515597664] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure. HYPOTHESIS An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion. RESULTS The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P = .012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95% CI, 1.1-2.2) and continued to increase to 2.4 (95% CI, 1.2-5.0) and 3.8 (95% CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure. CONCLUSION An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.
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Affiliation(s)
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William M Engasser
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark S Collins
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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36
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Anthropometric difference of the knee on MRI according to gender and age groups. Surg Radiol Anat 2015; 38:203-11. [PMID: 26253858 DOI: 10.1007/s00276-015-1536-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to analyze the anthropometric data from MRI images that were obtained from the non-arthritic knees in Asian adults, and to identify the existence of morphologic differences between age groups. This cross-sectional study included knee MR images of 535 patients (273 males, 262 females) taken for the evaluation of soft-tissue injuries, excluding cases with cartilage defect and malalignment. The age, gender, height, and BMI were also assessed. The patients were grouped into three different 20-year age groups (20-39, 40-59, and 60-79). The MRI analysis was performed on the anthropometric parameters of distal femur and posterior tibial slope. Age-related differences were found in femoral width, distance from the distal and posterior cartilage surface to the medial/lateral epicondyle, medial posterior condylar offset (PCO), and posterior condylar angle (PCA) (all P < 0.001), but not in lateral PCO, and medial/lateral tibial slopes. In the analysis of covariance analyses, significant interaction between gender and age groups was found in most parameters, but not in PCA, distance from the posterior cartilage surface to the medial epicondyle, or medial tibial slope. We found anthropometric differences among age groups exist in most of distal femoral parameters, but not in posterior tibial slope. The results of this study can be used by manufacturers to modify prostheses to be suitable for the future Asian elderly population.
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37
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[Flexion and extension osteotomy of the proximal tibia. Indications and surgical technique]. DER ORTHOPADE 2014; 43:976-83. [PMID: 25331501 DOI: 10.1007/s00132-014-3035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Isolated deviations in flexion and extension of the leg axis are rare. These deviations can be corrected if necessary by osteotomy and the range of motion (ROM) of the knee joint can be optimized. In addition to correction in the frontal plane, the tibial slope (i.e. inclination of the surface of the tibial joint) can also be influenced by osteotomy and therefore osteotomy can also be utilized to optimize the biomechanical stability of the knee joint. METHOD Careful planning taking all three spatial planes and torsion into consideration is the foundation of a successful operation. A controlled surgical technique based on careful planning and some basic principles allows the alteration of the three dimensional alignment of the tibia.
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38
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Boissonneault A, Lynch JA, Wise BL, Segal NA, Gross KD, Murray DW, Nevitt MC, Pandit HG. Association of hip and pelvic geometry with tibiofemoral osteoarthritis: multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage 2014; 22:1129-35. [PMID: 24971867 PMCID: PMC4195737 DOI: 10.1016/j.joca.2014.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/10/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lateral tibiofemoral osteoarthritis (OA) is overall less common than medial tibiofemoral OA, but it is more prevalent in women. This may be explained by sex differences in hip and pelvic geometry. The aim of this study is to explore sex differences in hip and pelvic geometry and determine if such parameters are associated with the presence of compartment-specific knee OA. METHODS This case-control study reports on 1,328 hips/knees from 664 participants and is an ancillary to the Multicenter Osteoarthritis Study (MOST). Of the 1,328 knees, 219 had lateral OA, 260 medial OA, and 849 no OA. Hip and pelvic measurements were taken from full-limb radiographs on the ipsilateral side of the knee of interest. After adjusting for covariates, means were compared between sexes and also between knees with medial and lateral OA vs no OA using separate regression models. RESULTS Women were shown to have a reduced femoral offset (FO) (mean 40.9 mm vs 45.9 mm; P = 0.001) and more valgus neck-shaft angle (mean 128.4° vs 125.9°; P < 0.001) compared to men. Compared to those with no OA, knees with lateral OA were associated with a reduced FO (P = 0.012), increased height of hip centre (HHC) (P = 0.003), more valgus neck-shaft angle (P = 0.042), and increased abductor angle (P = 0.031). Knees with medial OA were associated with a more varus neck-shaft angle (P = 0.043) and a decreased abductor angle (P = 0.003). CONCLUSION These data suggest anatomical variations at the hip and pelvis are associated with compartment-specific knee OA and may help to explain sex differences in patterns of knee OA.
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Affiliation(s)
- A Boissonneault
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - JA Lynch
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - BL Wise
- Center for Musculoskeletal Health, University of California, Davis School of Medicine, Davis, California, USA
| | - NA Segal
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - KD Gross
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - DW Murray
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - MC Nevitt
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - HG Pandit
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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39
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Khan N, Shepel M, Leswick DA, Obaid H. Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee? Skeletal Radiol 2014; 43:437-41. [PMID: 24414035 DOI: 10.1007/s00256-013-1800-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 12/04/2013] [Accepted: 12/11/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. MATERIALS AND METHODS A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). RESULTS In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. CONCLUSIONS Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings.
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Affiliation(s)
- Nasir Khan
- Department of Medical Imaging, Royal University Hospital, and College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada,
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40
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Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med 2013; 41:2800-4. [PMID: 24036571 DOI: 10.1177/0363546513503288] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An injury to the anterior cruciate ligament (ACL) is a multifactorial event influenced by intrinsic and extrinsic risk factors. Recently, the geometry of the proximal tibia has come under focus as a possible risk factor for an ACL injury. HYPOTHESIS An increased posterior tibial slope is associated with an increased risk of further ACL injuries in the previously ACL-reconstructed patient. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 200 consecutive patients with isolated ACL ruptures who underwent primary reconstruction with hamstring autografts were enrolled in a prospective longitudinal study over 15 years. The posterior tibial slope was measured from a lateral knee radiograph by 2 blinded observers. The data were analyzed for the association between an increased posterior tibial slope and the incidence of further ACL injuries. Interobserver reliability of the posterior tibial slope measurements was assessed. RESULTS Radiographs and follow-up were available for 181 of the 200 enrolled patients. Fifty patients had a further injury to either the ACL graft or the contralateral knee. The mean posterior tibial slope of those with a further ACL injury was 9.9° compared with 8.5° for those with no further injury (P = .001). The mean posterior tibial slope for those with both an ACL graft and contralateral ACL rupture was 12.9°. The odds of further ACL injuries after reconstruction were increased by a factor of 5, to an incidence of 59%, in those with a posterior tibial slope of ≥12°. CONCLUSION An increased posterior tibial slope is associated with increased odds of a further ACL injury after ACL reconstruction. The increased risk is most pronounced in those with a posterior tibial slope of ≥12°.
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Affiliation(s)
- Justin M Webb
- Lucy J. Salmon, The Mater Clinic, North Sydney Orthopaedic and Sports Medicine Centre, 3 Gilles Street, Suite 2, Wollstonecraft, Sydney, NSW, Australia, 2010.
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Lustig S, Scholes CJ, Balestro JC, Parker DA. In vivo assessment of weight-bearing knee flexion reveals compartment-specific alterations in meniscal slope. Arthroscopy 2013; 29:1653-60. [PMID: 23993055 DOI: 10.1016/j.arthro.2013.07.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of flexion angle on meniscal slope during partial weight-bearing knee flexion. METHODS Forty-eight sagittal sequences were performed on 12 patients (6 male patients, 6 female patients; 25.7 ± 10.5 years) during partial weight bearing in an open magnetic resonance imaging (MRI) scanner at full extension, 60°, 90°, and maximum knee flexion. A previously published method was used to measure the meniscal slope for each compartment using manual digitalization. A general linear model was used to test for effects of compartment and flexion angle on meniscal slope. RESULTS The mean maximum flexion angle achieved was 125° ± 10.5°. A significant main effect of compartment (P < .01) and flexion angle (P < .01) on meniscal slope was observed. A significant interaction between compartment and angle was also detected (P < .01). Specifically, the lateral meniscal slope was significantly more horizontal than the medial meniscus slope at full extension (P = .017) but significantly more posterior at all other angles. In addition, the lateral meniscus displayed a greater change in posterior slope across the range of motion compared with the medial meniscus. Significant correlations were found in medial meniscal slope at full extension and at maximum knee flexion (P = .031). CONCLUSIONS The results showed that meniscal slope in healthy knees increased significantly with knee flexion for both menisci, with significantly greater changes in the lateral meniscus. Furthermore, a lack of correlation was observed between the meniscal slope in extension and the meniscal slope at increasing flexion angles, questioning the efficacy of measuring the meniscal slope only in extension as commonly described. Overall, this study has provided valuable insight into how meniscal slope changes with knee motion.
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Affiliation(s)
- Sebastien Lustig
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia; Albert Trillat Center, Lyon North University, Lyon, France.
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