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Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the correlation between posterior tibial slope (PTS) and tibial tunnel widening after anterior cruciate ligament reconstruction (ACL-R).

Methods

Twenty-five patients underwent anatomic single-bundle ACL-R using quadriceps tendon autograft. Six months after surgery, each patient underwent high-resolution computed tomography (CT). Tibial tunnel aperture location was evaluated using a grid method. Medial and lateral PTS (°) was measured based on a previously described method. To evaluate tibial tunnel widening, cross-sectional area (CSA) of the tibial tunnel beneath the aperture was measured using CT axial slice. Nominal elliptical area was calculated using the diameter of a dilator during the surgery and the angle between the axial slice and the tunnel axis. Percentage of tunnel widening (%) was determined by dividing the CSA by the nominal area. Pearson correlation coefficient was used to explore the association between medial/lateral PTS and tibial tunnel widening (P < 0.05).

Results

Location of tibial tunnel aperture was 29.8 ± 6.3% in anterior–posterior direction, and 45.7 ± 2.1% in medial–lateral direction. Medial and lateral PTS were 3.7° ± 2.5° and 4.9° ± 2.4° respectively. Tibial tunnel widening was 97.2 ± 20.3%. Tibial tunnel widening was correlated with medial PTS (r = 0.558, P = 0.004) and lateral PTS (r = 0.431, P = 0.031).

Conclusion

Steeper medial and lateral PTS correlated with greater tibial tunnel widening. The clinical relevance is that surgeons should be aware that PTS may affect tibial tunnel widening after ACL-R. Thus, subjects with steeper PTS may need to be more carefully followed to see if there is greater tibial tunnel widening, which might be important especially in revision ACL-R.

Level of evidence

III.

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Abbreviations

ACL-R:

Anterior cruciate ligament reconstruction

PTS:

Posterior tibial slope

MRI:

Magnetic resonance imaging

ML:

Medial–lateral

AP:

Anterior–posterior

CT:

Computed tomography

TF:

Tibiofemoral

ICC:

Intraclass correlation coefficient

CSA:

Cross-sectional area

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Kanto Nagai, Yasutaka Tashiro, Elmar Herbst, Tom Gale, Joon Ho Wang, James J. Irrgang, William Anderst & Freddie H. Fu

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Kanto Nagai

  3. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Elmar Herbst

Authors
  1. Kanto Nagai
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  2. Yasutaka Tashiro
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  3. Elmar Herbst
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  4. Tom Gale
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  5. Joon Ho Wang
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  6. James J. Irrgang
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  7. William Anderst
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  8. Freddie H. Fu
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Corresponding author

Correspondence to Freddie H. Fu.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Funding

This research was funded by NIH/NIAMS, Grant No. R01 AR 056630.

Ethical approval

The institutional review board (IRB) for human subject research in University of Pittsburgh approved all aspects of this study (ID: PRO09020493).

Informed consent

Informed consent was obtained from all patients before the enrollment.

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Nagai, K., Tashiro, Y., Herbst, E. et al. Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 3717–3723 (2018). https://doi.org/10.1007/s00167-018-5004-5

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  • DOI: https://doi.org/10.1007/s00167-018-5004-5

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