Does an Increase in the Tibial Slope Angle Increase the Risk of Anterior Cruciate Ligament Re-rupture?

Yıl 2025, Cilt: 35 Sayı: 5, 854 - 862, 28.10.2025

Okan Ateş , Ahsen Oğul

https://doi.org/10.54005/geneltip.1647003

Öz

Backrounds/Aims: Despite the improvements in Anterior cruciate ligament recontruction (ACLR) surgery, results of revision surgeries are not satisfactory. Risk factors involved in ACLR are currently being studied to reduce re-injuries. In this study, the relationship between posterior tibial slope angle (PTSA) and rupture after primary and revision surgery was investigated.
Materials and Methosds: Patients over 18 years of age who underwent primary ACLR (primary group), patients with re-rupture (revision group) and individuals without any ligament injury (control group) were included in the study. Knee joint images of the participants were obtained by retrospective archive search. The posterior tibial slope angles in the included knee radiographs were measured using the anterior tibial cortex method.
Results: The study evaluated knee joint images of 124 patients in the primary group, 39 patients in the revision group and 100 participants in the control group. Intra-observer and inter-observer reliability of PTSA measurements was found to be appropriate. A statistically significant difference was observed between the mean tibial slope angle measurement of the control, primary and revision groups. (p=0,0001). It was found that the risk of primary anterior cruciate ligament (ACL) injury and ACL re-rupture for an individual with PTSA>11.4 was 7.6 times and 9.58 times higher, respectively, than for an individual with PTSA<11.4°.
Conclusion: Higher PTSA was observed to be an anatomical risk factor for primary and secondary ACL injuries. Patients with higher PTSA should be evaluated for additional risk factors and slope-reducing surgeries should be applied to these patients when necessary.

Anahtar Kelimeler

Anterior cruciate ligament , Tibial slope angle , Graft failure , Reconstruction , Revision surgery.

Tibial Eğim Açısının Artması Ön Çapraz Bağ Rekonstrüksiyonunda Rüptür Riskini Artırır mı?

Öz

Amaç: Ön çapraz bağ rekonstrüksiyonu (ÖÇBR) cerrahisindeki gelişmelere rağmen revizyon cerrahilerinin sonuçları tatmin edici değildir. ÖÇBR'de yer alan risk faktörleri şu anda yeniden yaralanmaları azaltmak için incelenmektedir. Bu çalışmada, posterior tibial eğim açısı (PTSA) ile primer ve revizyon cerrahisi sonrası meydana gelen rüptür arasındaki ilişki incelenmiştir.
Gereç ve Yöntem: Primer ÖÇBR geçiren 18 yaş üstü hastalar (primer grup), rerüptür olan hastalar (revizyon grubu) ve herhangi bir bağ yaralanması olmayan kişiler (kontrol grubu) çalışmaya dahil edilmiştir. Katılımcıların diz eklemi görüntüleri retrospektif arşiv aramasıyla elde edilmiştir. Dahil edilen diz radyografilerindeki posterior tibial eğim açıları anterior tibial korteks yöntemi kullanılarak ölçülmüştür.
Bulgular: Çalışmada primer gruptaki 124 hastanın, revizyon grubundaki 39 hastanın ve kontrol grubundaki 100 katılımcının diz eklemi görüntüleri değerlendirilmiştir. PTSA ölçümlerinin gözlemci içi ve gözlemciler arası güvenilirliğinin uygun olduğu bulunmuştur. Kontrol, primer ve revizyon gruplarının ortalama tibial eğim açısı ölçümü arasında istatistiksel olarak anlamlı bir fark gözlendi. (p=0,0001). PTSA>11,4 olan bir bireyde primer ön çapraz bağ (ÖÇB) yaralanması ve ÖÇB tekrar kopması riskinin sırasıyla PTSA<11,4° olan bir bireye göre 7,6 kat ve 9,58 kat daha yüksek olduğu bulundu.
Sonuç: Daha yüksek PTSA'nın primer ve sekonder ÖÇB yaralanmaları için anatomik bir risk faktörü olduğu gözlemlendi. Daha yüksek PTSA'ya sahip hastalar ek risk faktörleri açısından değerlendirilmeli ve gerektiğinde bu hastalara eğim azaltıcı cerrahiler uygulanmalıdır

Anahtar Kelimeler

Ön çapraz bağ , Tibial eğim açısı , Greft yetmezliği , Rekonstrüksiyon , Revizyon cerrahisi.

Kaynakça

• 1. Cirdi Y, Ergün S, Başcı O, Karahan M. Ön çapraz bağ rekonstrüksiyonu revizyonu. In: Taşer ÖF, Mahiroğulları M, Karahan M, Taşkıran E, Emin B, editors. Diz eklemi bağ ve tendon sorunları. İstanbul; 2016. p. 189–201.
• 2. Ahmed I, Salmon L, Roe J, Pinczewski L. The long-term clinical and radiological outcomes in patients who suffer recurrent injuries to the anterior cruciate ligament after reconstruction. Bone Joint J. 2017;99B(3):337–43.
• 3. Napier RJ, Garcia E, Devitt BM, Feller JA, Webster KE. Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2019;7(11):2325967119879373.
• 4. Cruz CA, Mannino BJ, Pike A, Thoma D, Lindell K, Kerbel YE, et al. Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice. J. ISAKOS. 2022;
• 5. Zee MJM, Keizer MNJ, Dijkerman L, van Raaij JJAM, Hijmans JM, Diercks RL. The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation. J Exp Orthop. 2021;8(1):1–8.
• 6. Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA. 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope. Am J Sports Med. 2017;46(3):531–43.
• 7. Gwinner C, Janosec M, Wierer G, Wagner M, Weiler A. Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope. Am J Sports Med. 2021;49(14):3802–8.
• 8. Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, et al. Surgical Techniques, Outcomes, Indications, and Complications of Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Revision Surgery: A Systematic Review. HSS J. 2019;15(2):176–84.
• 9. Chen Y, Ding J, Dai S, Yang J, Wang M, Tian T, et al. Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study. BMC Musculoskelet Disord. 2022;23(1):1–11.
• 10. Dæhlin L, Inderhaug E, Strand T, Parkar AP, Solheim E. The Effect of Posterior Tibial Slope on the Risk of Revision Surgery After Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2021;50(1):103–10.
• 11. Cooper JD, Wang W, Prentice HA, Funahashi TT, Maletis GB. The Association Between Tibial Slope and Revision Anterior Cruciate Ligament Reconstruction in Patients ≤21 Years Old: A Matched Case-Control Study Including 317 Revisions. Am J Sports Med. 2019;47(14):3330–8.
• 12. Liu Z, Jiang J, Yi Q, Teng Y, Liu X, He J, et al. An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2022;30(7):2377–87.
• 13. Lee CC, Youm YS, Cho S Do, Jung SH, Bae MH, Park SJ, et al. Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction? Arthroscopy. 2018;34(7):2152–5.
• 14. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior Tibial Slope and Further Anterior Cruciate Ligament Injuries in the Anterior Cruciate Ligament–Reconstructed Patient. Am J Sports Med. 2013;41(12):2800–4.
• 15. Tollefson L V., Rasmussen MT, Guerin G, LaPrade CM, LaPrade RF. Slope-Reducing Proximal Tibial Osteotomy Improves Outcomes in Anterior Cruciate Ligament Reconstruction Patients With Elevated Posterior Tibial Slope, Especially Revisions and Posterior Tibial Slope ≥12. Arthroscopy. 749.24 (2024).
• 16. Weinberg DS, Williamson DFK, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. https://doi.org/101177/0363546516662449. 2016;45(1):106–13.
• 17. Bernhardson AS, Aman ZS, Dornan GJ, Kemler BR, Storaci HW, Brady AW, et al. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019;47(2):296–302.
• 18. Sonnery-Cottet B, Mogos S, Thaunat M, Archbold P, Fayard JM, Freychet B, et al. Proximal Tibial Anterior Closing Wedge Osteotomy in Repeat Revision of Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2014;42(8):1873–80.
• 19. Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc.. 2015 23:10. 2015;23(10):2846–52.
• 20. Arun GR, Kumaraswamy V, Rajan D, Vinodh K, Singh AK, Kumar P, et al. Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope. Arch Orthop Trauma Surg. 2015 136:4. 2015;136(4):505–11.
• 21. Nazzal EM, Zsidai B, Pujol O, Kaarre J, Curley AJ, Musahl V. Considerations of the Posterior Tibial Slope in Anterior Cruciate Ligament Reconstruction: a Scoping Review. Curr Rev Musculoskelet Med 2022 15:4. 2022;15(4):291–9.