Hohmann Erik, Tetsworth Kevin, Glatt Vaida, Ngcelwane Mthunzi, Keough Natalie
Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
School of Medicine, University of Pretoria, Pretoria, South Africa.
Orthop J Sports Med. 2021 Aug 12;9(8):23259671211015940. doi: 10.1177/23259671211015940. eCollection 2021 Aug.
Higher posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) injury in men and women. The individual contribution of the lateral (LPTS) and medial (MPTS) slope has not yet been investigated.
To determine whether either the LPTS or the MPTS is an independent risk factor for ACL injury, and to determine sex-specific differences between patients with ACL-deficient and ACL-intact knees.
Cohort study; Level of evidence, 3.
We reviewed knee magnetic resonance (MR) images performed on ACL-deficient and ACL-intact knees between January 2018 and June 2020 at a single institution. Inclusion criteria were isolated ACL injury and noncontact mechanism (ACL-deficient group) and nonspecific knee pain and no history of injury (ACL-intact group). Exclusion criteria for both groups were the following: previous knee surgery; meniscal, collateral ligament, posterior cruciate ligament, or multiligamentous injuries; radiological evidence of osteoarthritis; and chondral damage on the tibia. The MR images were used to establish the posterior bony slope at 25%, 50%, and 75% from the medial and/or lateral border of the tibial plateau with respect to the proximal tibial anatomic axis. One-way analysis of variance (ANOVA) was used to determine differences in PTS at the 25%, 50%, and 75% distances for the medial and lateral tibial plateau between the groups and between the sexes.
Overall, 325 images were included (mean age, 36.1 ± 11.1 years; 142 ACL-deficient images [82 men and 60 women]; 183 ACL-intact images [112 men and 71 women]). MPTS and LPTS were significantly higher at 25%, 50%, and 75% in the ACL-deficient group (range, -2.7° to -5.7°) compared with the ACL-intact group (range, -2.1° to 1.5°; = .00001). Similarly, MPTS and LPTS were significantly different in men versus women ( = .00001). ANOVA revealed that there were no significant differences in PTS between men and women for all measures (MPTS, LPTS, ACL-deficient, ACL-intact; = .68).
The study results demonstrated that higher MPTS and LPTS is a potential risk factor for ACL injury in both men and women. However, despite being highly statistically significant, the differences between groups and sexes were small and may not be clinically relevant.
较高的胫骨后倾坡度（PTS）是男性和女性前交叉韧带（ACL）损伤的一个风险因素。外侧（LPTS）和内侧（MPTS）坡度的个体贡献尚未得到研究。
确定LPTS或MPTS是否为ACL损伤的独立风险因素，并确定ACL缺失和ACL完整膝关节患者之间的性别差异。
队列研究；证据等级，3级。
我们回顾了2018年1月至2020年6月在单一机构对ACL缺失和ACL完整膝关节进行的膝关节磁共振（MR）图像。纳入标准为孤立性ACL损伤和非接触机制（ACL缺失组）以及非特异性膝关节疼痛且无损伤史（ACL完整组）。两组的排除标准如下：既往膝关节手术史；半月板、侧副韧带、后交叉韧带或多韧带损伤；骨关节炎的放射学证据；以及胫骨软骨损伤。MR图像用于确定相对于近端胫骨解剖轴，在胫骨平台内侧和/或外侧边缘25%、50%和75%处的后骨坡度。采用单因素方差分析（ANOVA）来确定两组之间以及性别之间在胫骨平台内侧和外侧25%、50%和75%距离处PTS的差异。
总体而言，共纳入325幅图像（平均年龄，36.1±11.1岁；142幅ACL缺失图像[82名男性和60名女性]；183幅ACL完整图像[112名男性和71名女性]）。与ACL完整组（范围为-2.1°至1.5°；P=.00001）相比，ACL缺失组在25%、50%和75%处的MPTS和LPTS显著更高（范围为-2.7°至-5.7°）。同样，男性与女性之间的MPTS和LPTS也存在显著差异（P=.00001）。方差分析显示，所有测量指标（MPTS、LPTS、ACL缺失、ACL完整）在男性和女性之间的PTS均无显著差异（P=.68）。
研究结果表明，较高的MPTS和LPTS是男性和女性ACL损伤的潜在风险因素。然而，尽管在统计学上具有高度显著性，但组间和性别间的差异较小，可能在临床上不具有相关性。
