Dracic Anel, Zeravica Domagoj, Zovko Ivica, Jäger Marcus, Beck Sascha
Sportsclinic Hellersen, Lüdenscheid, Germany.
Orthopädische Klinik Volmarstein, Wetter, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):2896-2904. doi: 10.1002/ksa.12552. Epub 2024 Dec 6.
The significance of the posterior tibial slope (PTS) has increasingly come into focus in anterior cruciate ligament (ACL) reconstruction being a risk factor for ACL graft failure. Nevertheless, inconsistent data on the critical value of the PTS exist. The purpose of this study was to define a cut-off value for the PTS in ACL surgery.
In a retrospective cohort study, 350 revision ACL reconstructions (ACL-RR) with a failed ACL hamstring graft and 350 primary ACL reconstructions (ACL-R) were matched according to age, gender, concomitant injuries and graft characteristics and compared to a healthy control group. Using the proximal anatomic axis, lateral knee radiographs were evaluated for the PTS, interrater reliability was defined, ROC curves, Fischer's exact test and Baptista-Pike method were applied to define specificity and the odds ratio for a critical PTS value.
Radiographic evaluation proved excellent interrater reliability (intraclass correlation coefficient 0.969). Evaluation of the PTS revealed 10.0 ± 2.2 (5-15) degrees in the ACL-RR group, 7.8 ± 1.8 (4.2-13) degrees in the ACL-R group and 6.6 ± 1.9 (3.6-12) degrees in the control group with significant differences between the groups (p < 0.001). A PTS value of 10.1 degrees proved a specificity of 98% for the prediction of an ACL graft failure and indicated an 11-fold risk for a retear of the ACL.
A PTS exceeding 10.1 degrees carries an 11-fold risk for ACL graft failure and, therefore, should be considered in ACL reconstruction. These findings might serve as a cut-off value for the indication of a slope-reducing high tibial osteotomy in ACL surgery.
Level III.
胫骨后倾角（PTS）作为前交叉韧带（ACL）移植物失败的危险因素，在ACL重建中其重要性日益受到关注。然而，关于PTS临界值的数据并不一致。本研究的目的是确定ACL手术中PTS的临界值。
在一项回顾性队列研究中，根据年龄、性别、合并损伤和移植物特征，将350例ACL腘绳肌移植物失败的翻修ACL重建术（ACL-RR）与350例初次ACL重建术（ACL-R）进行匹配，并与健康对照组进行比较。使用近端解剖轴，对膝关节外侧X线片进行PTS评估，定义评分者间可靠性，应用ROC曲线、Fisher精确检验和Baptista-Pike方法确定临界PTS值的特异性和比值比。
影像学评估显示评分者间可靠性极佳（组内相关系数0.969）。PTS评估结果显示，ACL-RR组为10.0±2.2（5-15）度，ACL-R组为7.8±1.8（4.2-13）度，对照组为6.6±1.9（3.6-12）度，组间差异有统计学意义（p<0.001）。PTS值为10.1度时，预测ACL移植物失败的特异性为98%，提示ACL再次撕裂的风险增加11倍。
PTS超过10.1度时，ACL移植物失败的风险增加11倍，因此在ACL重建中应予以考虑。这些发现可作为ACL手术中进行胫骨高位截骨术以减小坡度的指征的临界值。
III级。
