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Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3717-3723. doi: 10.1007/s00167-018-5004-5. Epub 2018 Jun 4.

Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction.

Author information

1
Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
2
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
3
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
4
Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. ffu@upmc.edu.

Abstract

PURPOSE:

To investigate the correlation between posterior tibial slope (PTS) and tibial tunnel widening after anterior cruciate ligament reconstruction (ACL-R).

METHODS:

Twenty-five patients underwent anatomic single-bundle ACL-R using quadriceps tendon autograft. Six months after surgery, each patient underwent high-resolution computed tomography (CT). Tibial tunnel aperture location was evaluated using a grid method. Medial and lateral PTS (°) was measured based on a previously described method. To evaluate tibial tunnel widening, cross-sectional area (CSA) of the tibial tunnel beneath the aperture was measured using CT axial slice. Nominal elliptical area was calculated using the diameter of a dilator during the surgery and the angle between the axial slice and the tunnel axis. Percentage of tunnel widening (%) was determined by dividing the CSA by the nominal area. Pearson correlation coefficient was used to explore the association between medial/lateral PTS and tibial tunnel widening (P < 0.05).

RESULTS:

Location of tibial tunnel aperture was 29.8 ± 6.3% in anterior-posterior direction, and 45.7 ± 2.1% in medial-lateral direction. Medial and lateral PTS were 3.7° ± 2.5° and 4.9° ± 2.4° respectively. Tibial tunnel widening was 97.2 ± 20.3%. Tibial tunnel widening was correlated with medial PTS (r = 0.558, P = 0.004) and lateral PTS (r = 0.431, P = 0.031).

CONCLUSION:

Steeper medial and lateral PTS correlated with greater tibial tunnel widening. The clinical relevance is that surgeons should be aware that PTS may affect tibial tunnel widening after ACL-R. Thus, subjects with steeper PTS may need to be more carefully followed to see if there is greater tibial tunnel widening, which might be important especially in revision ACL-R.

LEVEL OF EVIDENCE:

III.

KEYWORDS:

ACL; Anterior cruciate ligament reconstruction; Bony morphology; Computed tomography; Cross-sectional area; Posterior tibial slope; Quadriceps tendon graft; Tibial tunnel location; Tunnel widening

PMID:
29869200
DOI:
10.1007/s00167-018-5004-5
[Indexed for MEDLINE]

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