Cut-off value for the posterior tibial slope indicating the risk for retear of the anterior cruciate ligament

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-12-06 DOI:10.1002/ksa.12552

Anel Dracic, Domagoj Zeravica, Ivica Zovko, Marcus Jäger, Sascha Beck

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Abstract

Purpose

The significance of the posterior tibial slope (PTS) has increasingly come into focus in anterior cruciate ligament (ACL) reconstruction being a risk factor for ACL graft failure. Nevertheless, inconsistent data on the critical value of the PTS exist. The purpose of this study was to define a cut-off value for the PTS in ACL surgery.

Methods

In a retrospective cohort study, 350 revision ACL reconstructions (ACL-RR) with a failed ACL hamstring graft and 350 primary ACL reconstructions (ACL-R) were matched according to age, gender, concomitant injuries and graft characteristics and compared to a healthy control group. Using the proximal anatomic axis, lateral knee radiographs were evaluated for the PTS, interrater reliability was defined, ROC curves, Fischer's exact test and Baptista–Pike method were applied to define specificity and the odds ratio for a critical PTS value.

Results

Radiographic evaluation proved excellent interrater reliability (intraclass correlation coefficient 0.969). Evaluation of the PTS revealed 10.0 ± 2.2 (5–15) degrees in the ACL-RR group, 7.8 ± 1.8 (4.2–13) degrees in the ACL-R group and 6.6 ± 1.9 (3.6–12) degrees in the control group with significant differences between the groups (p < 0.001). A PTS value of 10.1 degrees proved a specificity of 98% for the prediction of an ACL graft failure and indicated an 11-fold risk for a retear of the ACL.

Conclusion

A PTS exceeding 10.1 degrees carries an 11-fold risk for ACL graft failure and, therefore, should be considered in ACL reconstruction. These findings might serve as a cut-off value for the indication of a slope-reducing high tibial osteotomy in ACL surgery.

Level of Evidence

Level III.

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胫骨后斜度的临界值表明前交叉韧带再撕裂的风险。

目的：作为前交叉韧带（ACL）移植失败的危险因素，胫骨后斜度（PTS）在前交叉韧带（ACL）重建中的重要性越来越受到关注。然而，关于PTS临界值的数据并不一致。本研究的目的是确定前交叉韧带手术中PTS的临界值。方法：在一项回顾性队列研究中，根据年龄、性别、伴发损伤和移植物特征对350例ACL重建（ACL- rr）和350例ACL重建（ACL- r）进行匹配，并与健康对照组进行比较。使用近端解剖轴，评估膝关节侧位x线片的PTS，定义交叉可靠性，使用ROC曲线，Fischer精确检验和Baptista-Pike方法来定义特异性和关键PTS值的优势比。结果：x线片评价具有良好的组间信度（组内相关系数0.969）。结果显示，ACL- rr组PTS为10.0±2.2（5-15）度，ACL- r组为7.8±1.8（4.2-13）度，对照组为6.6±1.9（3.6-12）度，两组间差异有统计学意义(p)。结论：PTS超过10.1度，ACL移植失败风险增加11倍，应考虑ACL重建。这些发现可以作为前交叉韧带手术中斜降高位胫骨截骨指征的临界值。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).