Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice

Christian A Cruz; Brian J Mannino; Andrew Pike; David Thoma; Kenneth Lindell; Yehuda E Kerbel; Austin McCadden; Andrew J Lopez; Craig R Bottoni

doi:10.1016/j.jisako.2022.04.002

Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice

J ISAKOS. 2022 Oct;7(5):100-104. doi: 10.1016/j.jisako.2022.04.002. Epub 2022 Apr 13.

Authors

Christian A Cruz¹, Brian J Mannino², Andrew Pike², David Thoma³, Kenneth Lindell³, Yehuda E Kerbel⁴, Austin McCadden², Andrew J Lopez², Craig R Bottoni²

Affiliations

¹ Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA. Electronic address: chcruz93@gmail.com.
² Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
³ Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA.
⁴ Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 37873691
DOI: 10.1016/j.jisako.2022.04.002

Abstract

Introduction: Anterior cruciate ligament (ACL) reconstruction failure remains a commonly seen complication despite advances in technique and graft options. Recently, several studies have shown that the inclination of the tibial plateau in the sagittal plane affects the stability of the knee joint. The purpose of this study was to determine if an increased posterior slope of the tibia is associated with failure of ACL reconstruction irrespective of the graft used.

Methods: From June 2002 to August 2003, a total of 100 patients with a symptomatic ACL-deficient knee were randomised to receive either a hamstring autograft or posterior tibialis allograft. All allografts were from a single tissue bank, aseptically processed, and fresh-frozen without terminal irradiation. ACL graft failures requiring reoperation with a minimum of 10-year follow-up were identified via telephone survey. Lateral radiographs of the knee of all patients were reviewed, and the slope of the tibia was measured using a standardised technique. Two fellowship-trained orthopaedic sports medicine specialists, one board-certified general orthopaedic surgeon, and two fellowship-trained musculoskeletal radiologists measured the tibial slope in all patients.

Results: At a minimum of 10-year follow-up, there were four (8.3%) autograft and 13 (26.5%) allograft failures that required revision reconstruction. The overall average tibial slope of the nonfailure cohort was 9.4°. The overall average tibial slope of the failure cohort was 11.9° (P = 0.0002). The average slope of the allograft failures was 11.5°compared with an average slope of 9.6° in the nonfailures (P = 0.01). The average slope of the autograft failures was 13.1° compared with 9.3° in the nonfailures (P = 0.011). The mean difference in tibial slope measurements was 0.665 (95% confidence interval: 0.569-0.750). The interrater reliability, as measured by the intraclass correlation coefficient, for tibial slope was 0.898 (95% confidence interval: 0.859-0.928). The Cronbach α was 0.904.

Conclusion: In a prospective, randomised trial of ACL reconstructions using either autograft or allograft, failures were associated with a significantly increased slope of the tibia compared with the nonfailures at 10-year follow-up.

Keywords: Allograft; Anterior cruciate ligament; Autograft; Failure; Posterior tibial slope.

Published by Elsevier Inc.

Publication types

Randomized Controlled Trial

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction* / methods
Humans
Prospective Studies
Reproducibility of Results
Risk Factors
Tibia / surgery