Ayuob Atif, Raj Siddarth, Jessup Jonathan, Searle Henry K C, Ahmed Imran, Thompson Peter, Shah Feisal, Metcalfe Andrew, Smith Nicholas
University Hospital Coventry & Warwickshire, University Hospitals Coventry and Warwickshire (UHCW) NHS Trust, Coventry, England, UK.
Am J Sports Med. 2025 Aug;53(10):2387-2396. doi: 10.1177/03635465251355213. Epub 2025 Jul 21.
Anterior cruciate ligament reconstruction (ACLR) failures are linked to various risk factors, including an increased posterior tibial slope (PTS). Recent studies have indicated that both the medial PTS (MPTS) and lateral PTS (LPTS) contribute to ACLR outcomes, but the clinical importance of their difference-delta angle-has not been previously explored.
The delta angle, or the difference between the lateral and medial PTSs, is a more significant predictor of ACLR rerupture than either slope considered individually.
Case series; Level of evidence, 4.
The authors conducted a retrospective analysis of the medical records of 1174 patients who underwent primary, contralateral, or revision ACLR from 2007 to 2018 at a single institution. Medial and lateral PTSs were measured on lateral knee radiographs, and the delta angle was calculated as LPTS minus MPTS. Logistic regression analysis was used to assess the association between these variables and ACLR outcomes, adjusting for potential confounders, such as age and sex.
The mean delta angle was significantly lower in the primary ACLR group compared with the revision ACLR group (3.1°± 2.3° vs 6.2°± 2.2°; < .001). Isolated high LPTS was a better predictor of ACLR reruptures than isolated high MPTS. The delta angle was significantly associated with an increased risk of revision surgery (OR, 1.675; 95% CI, 1.618-1.968; < .001).
The delta angle is a crucial risk factor for ACLR failure, with a higher delta angle significantly associated with higher odds of ACLR revision. These findings suggest that consideration of both medial and lateral PTSs, and particularly their difference, should be integral in assessing ACLR risk and planning surgical interventions.
前交叉韧带重建（ACLR）失败与多种风险因素相关，包括胫骨后倾坡度（PTS）增加。近期研究表明，内侧PTS（MPTS）和外侧PTS（LPTS）均对ACLR结果有影响，但两者差异——角度差——的临床重要性此前尚未得到探讨。
角度差，即外侧与内侧PTS的差值，比单独考虑的任何一个坡度更能显著预测ACLR再断裂。
病例系列研究；证据等级，4级。
作者对2007年至2018年在单一机构接受初次、对侧或翻修ACLR的1174例患者的病历进行了回顾性分析。在膝关节侧位X线片上测量内侧和外侧PTS，并计算角度差，即LPTS减去MPTS。采用逻辑回归分析评估这些变量与ACLR结果之间的关联，并对年龄和性别等潜在混杂因素进行校正。
初次ACLR组的平均角度差显著低于翻修ACLR组（3.1°±2.3°对6.2°±2.2°；P<.001）。孤立的高LPTS比孤立的高MPTS更能预测ACLR再断裂。角度差与翻修手术风险增加显著相关（比值比，1.675；95%可信区间，1.618 - 1.968；P<.001）。
角度差是ACLR失败的关键风险因素，角度差越大，ACLR翻修的几率越高。这些发现表明，在评估ACLR风险和规划手术干预时，应综合考虑内侧和外侧PTS，尤其是它们的差异。
