Steep tibial slope correlates with inferior patient‑reported knee function independent of tunnel widening

IF 5.5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-08-24 Epub Date: 2025-10-22 DOI:10.1002/ksa.70096

Anel Dracic, Domagoj Zeravica, Semin Becirbegovic, Marcus Jäger, Sascha Beck

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引用次数: 0

Abstract

Purpose

The purpose of this study was to evaluate any association between posterior tibial slope (PTS), graft failure, clinical outcome and bone tunnel widening following anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft.

Methods

A retrospective, case–control study was conducted comparing 350 revision ACL reconstructions (ACL-RRs) with 350 primary ACL reconstructions (ACL-Rs). A hamstring autograft was used for reconstruction in all cases. PTS and femoral/tibial tunnel diameters were measured on plain anteroposterior (AP) and on lateral radiographs after surgery, prior to ACL revision surgery and at follow-up (FU). Clinical outcome was assessed at FU using the Lysholm score. Associations between PTS and Lysholm score were tested with linear regression (adjusted for age, sex and body mass index [BMI]). Tunnel enlargement was analyzed using Welch's test and correlated with PTS. The study demonstrated 97% power for the primary Lysholm model.

Results

ACL graft failure was significantly associated with a higher PTS (7.9 ± 1.8° in ACL-R vs. 10.0 ± 2.1° in ACL-RR, p < 0.001). At FU (35.5 ± 9.2 months), no significant widening of bone tunnels related to tibial inclination occurred, whereas subjective outcome was significantly affected (p < 0.001) by a steep PTS. In knees exceeding a PTS threshold of 10°, each degree increase in PTS was associated with a 1.1-point decrease in Lysholm score. The difference in clinical outcome of knees with a PTS < 10° and  those ≥10° measured 5–6 points and exceeded the established minimal clinically important difference (≈5.5 pts). The proportion of patients reaching a patient acceptable symptom state (≥80 pts) lowered from ≈85% to ≈60%. Adjusted for sex and age, in subjects with a PTS ≥ 10°, the Lysholm score was approximately 4.3 points lower than in those with a PTS < 10°. Regardless of PTS, BMI had a negative effect on clinical outcome (p < 0.001).

Conclusion

An elevated PTS was not only associated with ACL graft failure but also contributed to poorer outcomes following ACLR. However, no association between PTS and bone tunnel expansion could be detected, suggesting other mechanisms for graft failure and reduced knee function.

Level of Evidence

Level III, retrospective comparative study.

查看原文本刊更多论文

胫骨陡坡与患者报告的较差膝关节功能相关，与隧道加宽无关。

目的：本研究的目的是评估使用腘绳肌腱自体前交叉韧带重建（ACLR）后胫骨后坡（PTS）、移植物失败、临床结果和骨隧道拓宽之间的关系。方法：回顾性病例对照研究，比较350例ACL修复重建（ACL- rs）和350例原发性ACL重建（ACL- rs）。所有病例均采用腘绳肌腱自体移植物进行重建。术后、ACL翻修手术前和随访时分别在平正位（AP）和侧位片上测量PTS和股骨/胫骨隧道直径。使用Lysholm评分评估FU的临床结果。PTS与Lysholm评分之间的关系采用线性回归检验（调整年龄、性别和体重指数[BMI]）。采用Welch’s检验分析隧道扩大并与PTS相关。该研究表明，初级Lysholm模型的有效性为97%。结果：ACL移植失败与更高的PTS显著相关（ACL- r为7.9±1.8°，ACL- rr为10.0±2.1°），p结论：升高的PTS不仅与ACL移植失败相关，而且与ACLR后较差的预后有关。然而，未发现PTS与骨隧道扩张之间的关联，提示移植物失败和膝关节功能降低的其他机制。证据等级： III级，回顾性比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).