Is an excessively high posterior tibial slope a predisposition to knee injuries in children? Systematic review of the literature.

Background: The literature agrees that an increased posterior tibial slope (PTS) increases the risk of anterior cruciate ligament (ACL) rupture in adults. However, there is no consensus on the average normal value and it varies with growth. We carried out a systematic review of the literature to answer 4 questions faced with an increase in PTS in children: METHOD: We conducted a systematic review of the literature in accordance with PRISMA criteria. The inclusion criteria were all studies analyzing the association between increased PTS and the occurrence of knee disease in patients, the majority of whom were under 18 years of age or had immature skeletons. For each study, we recorded the demographic characteristics of the patients, the type of measurements performed, the PTS values and the association between the PTS value and the occurrence of pathology.

Results: A total of 294 studies were identified. After analysis, 11 studies were included (n = 1173 patients). Six studies examined the association between PTS and anterior cruciate ligament (ACL) rupture (n = 5) or recurrence of rupture (n = 1). Two studies investigated the association between tibial slope and proximal tibial fracture and 3 studies investigated the association between tibial slope and growth disease (Osgood Schlatter (OSD) or osteochondritis dissecans of the knee). Of the 5 ACL studies, all studies found a significant increase in PTS in patients with ACL rupture (range min 2.1 ° max 4.3 °) compared with healthy subjects. Concerning growth lesions, 3 studies found an increased PTS in patients with OSD or osteochondritis. The studies concerning fractures of the proximal end of the tibia also found an increase in PTS.

Conclusions: This review highlighted the potential link between an abnormally high PTS value and the occurrence of knee pathologies in children, in particular ACL rupture. Children with a high PTS and an ACL rupture will require longer-term follow-up and should be warned of the greater risk of re-rupture.

Level of evidence: IV; systematic review.