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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

09-01-2023 | KNEE

High prevalence of increased posterior tibial slope in ACL revision surgery demands a patient-specific approach

Authors: Wouter Beel, Philipp Schuster, Stefan Michalski, Philipp Mayer, Michael Schlumberger, Lotta Hielscher, Jörg Richter

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2023

Abstract

Purpose

To determine the prevalence of an “increased posterior tibial slope (PTS)” (PTS ≥ 12°) in a population with one, two or ≥ three anterior cruciate ligament (ACL) graft insufficiencies. Furthermore, to investigate whether the prevalence of an increased PTS and the absolute PTS increases with an increasing number of ACL graft insufficiencies, as well as to determine the survival time of the first ACL graft.

Methods

Patients diagnosed with an ACL graft insufficiency between January 2021 and March 2022 were included. The PTS was measured using the proximal anatomical tibial axis on long lateral knee radiographs. Patients were divided into 3 groups depending on the number of ACL graft insufficiencies: group A (1 graft insufficiency), group B (2 graft insufficiencies) and group C (≥ 3 graft insufficiencies). The prevalence of increased PTS and absolute PTS between groups was compared alongside the survival of the first ACL graft between patients with or without increased PTS.

Results

Two-hundred and six patients (147 males/59 females) met the inclusion criteria. 73 patients showed an increased PTS [prevalence 35% [95% confidence interval (CI) (29%; 42%)]. 155 patients were found in category A, 42 patients in B and 9 patients in C. The prevalence of increased PTS for group A, B and C was, 32% [95% CI (25%; 40%)], 38% [95% CI (23%; 53%)] and 78% [95% CI (51%; 100%)], respectively. The prevalence of increased PTS and mean PTS did not increase significantly between group A and B. However, both parameters increased significantly between group A and C, and group B and C (p < 0.05). The survival time of the first ACL graft in patients with or without an increased PTS was 3 (interquartile range (IQR) 5) and 6 years (IQR 9), respectively (p < 0.05).

Conclusion

There is a 35% prevalence of increased PTS in the studied ACL graft insufficient patient cohort. The survival of the first ACL graft is shorter in patients with an increased PTS. Surgeons should be aware of the high prevalence of increased PTS when consulting patients for revision ACL reconstruction as it is an important risk factor for recurrent instability.

Level of evidence

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Title: High prevalence of increased posterior tibial slope in ACL revision surgery demands a patient-specific approach
Authors: Wouter Beel
Philipp Schuster
Stefan Michalski
Philipp Mayer
Michael Schlumberger
Lotta Hielscher
Jörg Richter
Publication date: 09-01-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07313-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High prevalence of increased posterior tibial slope in ACL revision surgery demands a patient-specific approach

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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