Okoro Sylvester I, Taylor Vanessa, Troyer Stockton, Alayleh Amin, Ellis Henry B, Yen Yi-Meng, Tompkins Marc, Ganley Theodore, Chan Charles, Shea Kevin G
Morehouse School of Medicine, Atlanta, GA, USA.
Stanford University, Stanford, CA, USA.
J ISAKOS. 2025 Jun;12:100869. doi: 10.1016/j.jisako.2025.100869. Epub 2025 Apr 25.
Increased knee posterior tibial slope (PTS) angle elevates anterior cruciate ligament (ACL) strain and ACL injury risk. Adult biomechanical research indicates that decreasing the PTS may reduce ACL injuries. Younger patients have much higher risk of ACL injury than adults, with limited anatomic research on tibial slope. The purpose of this study is to evaluate the pediatric medial and lateral PTS in a larger cohort group than prior research.
Eighty-three computed tomography (CT) scans of the knee from children aged <2 to 11 years were evaluated using OsiriX imaging software. The PTS was evaluated at two distinct points on sagittal CT sections: (1) At the medial and 2) lateral tibial plateaus, both aligned with the central part of the coronal view of the femoral condyles.
The medial and lateral PTS demonstrated variability across ages <2 to 11 years, with mean values ranging from 3.6° ± 1.8°-8.7° ± 5.3° for medial slopes and 5.1° ± 3.3°-12.4° ± 3.6° for lateral slopes. The proportion of patients with at least one slope >10° peaked at age 8 (100 %) and age 6 (67 %). Simple linear regression revealed no statistically significant relationship between age and tibial slope for medial (coefficient of -0.07, p = 0.574, R = 0.004) or lateral slopes (coefficient of -0.08, p = 0.459, R = 0.007).
Corrective osteotomy of increased PTS to lower the risk of ACL injury may be performed in high injury risk adult patients. However, such invasive procedures are not recommended for the skeletally immature because osteotomy in the growth plates in the proximal tibia could induce growth disturbance. In a unique skeletally immature patient with high risk of recurrent ACL injury, guided growth might be an option in high risk for lowering PTS in a controlled manner. As younger patients have some of the higher risks of primary and recurrent ACL injury, future research in this area may offer another approach to lower the risk of these injuries.
Level III.
膝关节后胫骨坡度（PTS）角度增加会提高前交叉韧带（ACL）的应变和ACL损伤风险。成人生物力学研究表明，减小PTS可能会降低ACL损伤。年轻患者ACL损伤的风险比成年人高得多，而关于胫骨坡度的解剖学研究有限。本研究的目的是在比以往研究更大的队列组中评估儿童的内侧和外侧PTS。
使用OsiriX成像软件评估了83例年龄小于2至11岁儿童的膝关节计算机断层扫描（CT）。在矢状面CT切片上的两个不同点评估PTS：（1）内侧和（2）外侧胫骨平台，均与股骨髁冠状视图的中心部分对齐。
内侧和外侧PTS在2至11岁年龄段之间存在差异，内侧坡度的平均值范围为3.6°±1.8°至8.7°±5.3°，外侧坡度的平均值范围为5.1°±3.3°至12.4°±3.6°。至少有一个坡度>10°的患者比例在8岁（100%）和6岁（67%）时达到峰值。简单线性回归显示，年龄与内侧坡度（系数为-0.07，p = 0.574，R = 0.004）或外侧坡度（系数为-0.08，p = 0.459，R = 0.007）之间无统计学显著关系。
对于ACL损伤风险高的成年患者，可进行增加PTS的矫正截骨术以降低风险。然而，不建议对骨骼未成熟的患者进行这种侵入性手术，因为胫骨近端生长板的截骨术可能会导致生长紊乱。在具有复发性ACL损伤高风险的独特骨骼未成熟患者中，引导生长可能是一种以可控方式降低PTS高风险的选择。由于年轻患者原发性和复发性ACL损伤的风险较高，该领域的未来研究可能会提供另一种降低这些损伤风险的方法。
三级。
