Original Article
Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction?

https://doi.org/10.1016/j.arthro.2018.01.058Get rights and content

Purpose

The purpose of this study was to evaluate the association between posterior tibial slope (PTS) and anterior cruciate ligament (ACL) graft rupture in patients who have undergone ACL reconstruction by comparing results in patients who experienced graft rupture and a matched control group.

Methods

The study included 64 knees of 64 patients (58 men and 6 women), of mean age 31 years (range, 18-60 years) who underwent revision ACL reconstruction for ACL graft rupture, as well as a control group without ACL graft rupture matched for age, sex, body mass index (BMI), and left or right side. The mean time to failure in study group was 48.5 months, and after revision surgeries, the mean follow-up period was 37.7 months. The graft used for the primary surgery was autograft in 3 patients (4.7%) and allograft in 49 patients (76.6%). The type of graft could not be confirmed in the remaining 12 patients (18.7%). PTS was measured on plain radiographs and compared in the 2 groups.

Results

Mean PTS was significantly higher in patients with (13.2° ± 2.5°; range, 8.5°-18.2°) than without (10.9° ± 3.1°; range, 4.9°-13.6°) rerupture (P < .01). When mean PTS was compared in the 37 patients who underwent primary surgery by the same surgeon, it was significantly higher in patients with (13.5° ± 2.5°; range, 8.5°-18.2°) than without (11.1° ± 2.9°; range, 5.1°-13.6°) rerupture (P < .01). PTS in patients with rerupture was not significantly associated with age, gender, BMI, and right or left side. The odds ratio of ACL graft rupture in knees with PTS ≥12° was 4.52 (P < .001).

Conclusions

This study showed that mean PTS was significantly greater in patients with than without noncontact ACL graft rerupture (13.2° vs 10.9°, P < .01). The failure of ACL reconstruction appears to be associated with increased PTS, with PTS ≥12° a risk factor for the failure of ACL reconstruction.

Level of Evidence

Level III, retrospective comparative study.

Section snippets

Methods

The study included 64 knees of 64 patients who underwent revision ACL reconstruction for ACL graft rupture by a noncontact mechanism from April 2005 to October 2014. Noncontact ACL injury occurs without direct physical contact with other people or objects at the time of injury. The study population consisted of 58 men and 6 women, of mean age 31 years (range, 18-60 years; Table 1). Of the 64 patients, 31 underwent operation on the right knee and 33 on the left knee; 37 underwent index surgery

Results

Mean PTS was significantly higher in patients with (13.2° ± 2.5°; range, 8.5°-18.2°) than without (10.9° ± 3.1°; range, 4.9°-13.6°) rerupture (P < .01; Table 2). When mean PTS was compared in the 37 patients who underwent primary surgery by the same surgeon, it was significantly higher in patients with (13.5° ± 2.5°; range, 8.5°-18.2°) than without (11.1° ± 2.9°; range, 5.1°-13.6°) rerupture (P < .01).

Subgroup analysis of patients with rerupture showed that the mean PTS did not differ

Discussion

This study showed that mean PTS was significantly greater in patients who experienced ACL graft rupture than in matched control patients. However, PTS in patients with ACL graft rupture was not associated with age, gender, BMI, or right or left side injury.

The anatomical factors of a distal femur and a proximal tibia may affect ACL injury.1, 2, 3, 4, 5 Although no consensus has been reached to date, the relationship between PTS and ACL injury has received considerable attention.21, 22, 23, 24

Conclusions

This study showed that mean PTS was significantly greater in patients with than without noncontact ACL graft rerupture (13.2° vs 10.9°, P < .01). The failure of ACL reconstruction appears to be associated with increased PTS, with PTS ≥ 12° a risk factor for the failure of ACL reconstruction.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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