Measurement technique for posterior tibial slope on radiographs can affect its relationship to the risk of anterior cruc
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ORIGINAL PAPER
Measurement technique for posterior tibial slope on radiographs can affect its relationship to the risk of anterior cruciate ligament rupture Edoardo Gaj 1 & Edoardo Monaco 1 & Angelo De Carli 1 & Megan Rianne Wolf 2 & Carlo Massafra 1 & Andrea Redler 1 & Daniele Mazza 1 & Andrea Ferretti 1 Received: 5 February 2020 / Accepted: 30 October 2020 # SICOT aisbl 2020
Abstract Purpose The purpose of this study was to determine the most reliable radiographic measurement method to evaluate PTS as a risk factor for ACL reconstruction failure. Methods Patients who underwent ACL reconstruction or ACL revision reconstruction between January 2009 and December 2014 by a single surgeon were included. Fifty-two consecutive patients who underwent ACL revision reconstruction were compared to a random selection of 52 patients who underwent primary ACL reconstruction and a control group of 52 patients without ACL injury. ACL reconstruction was performed using either ipsilateral (primary) or contralateral (revision) quadrupled hamstring autograft. Lateral knee radiographs were evaluated using three methods: (1) longitudinal axis, (2) anterior tibial cortex axis, and (3) posterior tibial cortex. Results A significant difference was found between subjects who underwent ACL reconstruction and control knees (6.79° vs. 5.31°, p = 0.046) using the posterior tibial cortex method. No other statistical significance was found between groups. A multiple linear regression analysis found that the PTS as measured by any method was not affected by the patient’s age, sex, height, weight, and BMI. All methods of measurement for PTS demonstrated excellent (ICC > 0.90) intra-rater and inter-rater reliability, but only the posterior tibial cortex method maintained excellent intra-rater and inter-rater reliability (ICC > 0.90) when evaluating patients with ACL revision reconstruction. Conclusions The posterior tibial cortex measurement is the most reliable method for analyzing the PTS on lateral knee radiographs in patients undergoing ACL revision reconstruction. Keywords Anterior cruciate ligament . Posterior tibial slope . ACL reconstruction failure . ACL reconstruction revision
Introduction Despite significant research and interventions, non-contact anterior cruciate ligament (ACL) tears remain common athletic injuries, leading investigators to identify risk factors that may predispose athletes to injury [1]. Only by understanding the factors leading to injury may successful injury prevention Level of Evidence: Level III. Study Design: Retrospective case-control study * Daniele Mazza [email protected] 1
Department of Orthopaedic Surgery, University of Rome “La Sapienza”, Sant’Andrea Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy
2
U-Conn, Storrs, CT 06269, USA
algorithms be developed. Risk factors are commonly classified into four categories: environmental, neuromuscular, hormonal, and anatomical [2]. While anatomy may be difficult to modify, identifying these factors may lead to more aggressive prevention regimens fo
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