胫骨后内侧坡度较陡与双侧前交叉韧带损伤相关：与单侧病例的影像学比较。
Steeper medial posterior tibial slope is associated with bilateral ACL injuries: A radiographic comparison with unilateral cases.
作者信息
Druel Julien, Laidet Paul, Khajuria Apoorva, Piercecchi Antoine, Argenson Jean-Noël, Jacquet Christophe, Sammartino Fabio, Ollivier Matthieu
机构信息
Department of Orthopedic Surgery, Institute for Locomotion Aix-Marseille University Marseille France.
Department of Biomechanics, APHM, CNRS, ISM, St. Marguerite Hospital, Institute for Locomotion Aix-Marseille University Marseille France.
出版信息
J Exp Orthop. 2025 Sep 4;12(3):e70424. doi: 10.1002/jeo2.70424. eCollection 2025 Jul.
PURPOSE
The posterior tibial slope (PTS) plays a key role in knee biomechanics and may influence the risk of anterior cruciate ligament (ACL) rupture as well as the outcomes of its reconstruction. We hypothesised that a steeper medial posterior tibial slope (MPTS) would be associated with an increased risk of bilateral ACL reconstruction compared to unilateral reconstruction. This study aimed to test this hypothesis by comparing the MPTS between patients undergoing unilateral ACL reconstruction (uniACLR) and those requiring non-simultaneous bilateral ACL reconstruction (biACLR), using radiographic imaging.
METHODS
This single-centre retrospective study included 114 patients (57 uniACLR, 57 biACLR), matched by age, gender, body mass index (BMI), and presence of meniscal injury. The MPTS was measured on standardised lateral radiographs. Meniscal, cartilage, and ligamentous injuries were evaluated arthroscopically. Statistical analyses included univariate and multivariate models, with a significance threshold of < 0.05.
RESULTS
Patients in the biACLR group demonstrated a significantly higher MPTS compared to the uniACLR group (mean ± SD: 12.39° ± 2.74° vs. 8.16° ± 1.67°; mean difference 4.23°, 95% confidence interval: 3.35°-5.11°; < 0.0001). No significant differences were observed between groups in meniscal, cartilaginous lesions, graft selection, use of lateral extra-articular tenodesis, or reoperation rates. Subgroup analysis indicated that higher MPTS was particularly associated with meniscal root tears.
CONCLUSION
A steeper MPTS is significantly associated with bilateral ACL reconstruction, suggesting it may represent an anatomical risk factor for repeated ACL injuries. Systematic assessment of MPTS may help identify patients at higher risk of contralateral ACL injury, aiding in surgical planning and postoperative monitoring.
LEVEL OF EVIDENCE
Level III, retrospective comparative cohort study.
目的
胫骨后倾坡度（PTS）在膝关节生物力学中起关键作用，可能影响前交叉韧带（ACL）断裂风险及其重建效果。我们假设，与单侧重建相比，内侧胫骨后倾坡度（MPTS）更陡会增加双侧ACL重建的风险。本研究旨在通过影像学检查比较单侧ACL重建（uniACLR）患者与非同期双侧ACL重建（biACLR）患者的MPTS，以验证这一假设。
方法
本单中心回顾性研究纳入114例患者（57例uniACLR，57例biACLR），根据年龄、性别、体重指数（BMI）和半月板损伤情况进行匹配。在标准化的侧位X线片上测量MPTS。通过关节镜评估半月板、软骨和韧带损伤情况。统计分析包括单因素和多因素模型，显著性阈值为<0.05。
结果
与uniACLR组相比，biACLR组患者的MPTS显著更高（均值±标准差：12.39°±2.74° vs. 8.16°±1.67°；平均差异4.23°，95%置信区间：3.35°-5.11°；<0.0001）。两组在半月板、软骨损伤、移植物选择、外侧关节外腱固定术的使用或再次手术率方面未观察到显著差异。亚组分析表明，较高的MPTS尤其与半月板根部撕裂有关。
结论
更陡的MPTS与双侧ACL重建显著相关，表明它可能是复发性ACL损伤的解剖学危险因素。对MPTS进行系统评估可能有助于识别对侧ACL损伤风险较高的患者，辅助手术规划和术后监测。
证据水平
III级，回顾性比较队列研究。
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