Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Predictive Risk Factors of Primary Anterior Cruciate Ligament Reconstruction Failure: A Case-Control Study With Prospectively Collected Data
Background:
Steep posterior tibial slope (PTS) and excessive anterior tibial translation (ATT) have been identified as important anatomic risk factors for anterior cruciate ligament (ACL) injury, which have raised concerns about clinical outcomes after primary ACL reconstruction (ACLR).
Purpose:
To investigate anatomic risk factors of primary ACLR failure and to determine the cutoff values of PTS and ATT for predicting primary ACLR failure.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Between November 2015 and May 2017, a total of 215 consecutive patients with clinically diagnosed noncontact ACL injuries who underwent primary anatomic ACLR were retrospectively analyzed. Among them, 25 patients who showed complete discontinuity of ACL fibers on final follow-up magnetic resonance imaging scans were allocated into the failure group (study group). They were matched 1:2 to 50 control participants who showed clear and continuous ACL fibers on magnetic resonance imaging scans (control group). PTS and ATT were measured on preoperative weightbearing whole leg lateral radiographs and compared between the groups. The cutoff values of PTS and ATT for predicting primary ACLR failure were determined by the receiver operating characteristic curve. Moreover, predictors of primary ACLR failure were assessed by multivariate logistic regression analysis, including sex, age, body mass index, concomitant meniscal tears, degree of pivot-shift test, and KT-1000 arthrometer side-to-side difference, PTS, and ATT.
Results:
PTS and ATT values in the study group were significantly higher than those in the control group (mean ± SD: PTS, 17.2°± 2.2° vs 14.4°± 2.8°; ATT, 8.3 ± 3.4 mm vs 4.1 ± 3.1 mm; P < .001). The cutoff values of PTS and ATT for predicting primary ACLR failure were 17° (sensitivity, 66.7%; specificity, 90.9%) and 6 mm (sensitivity, 87.5%; specificity, 79.5%), respectively. Additionally, PTS ≥17° (odds ratio, 15.6; 95% CI, 2.7-91.5; P = .002) and ATT ≥6 mm (odds ratio, 9.9; 95% CI, 1.9-51.4; P = .006) were determined to be risk factors of primary ACLR failure, whereas sex, age, body mass index, concomitant meniscal tears, degree of the pivot-shift test, and KT-1000 arthrometer side-to-side difference were not.
Conclusion:
In this study, PTS ≥17° and ATT ≥6 mm, as measured on weightbearing whole leg radiographs, were identified to be predictive risk factors of primary ACLR failure. This study adds to the existing knowledge about potential surgical indications of simultaneous slope-reducing high tibial osteotomy to mitigate the primary ACLR failure rate.
Top-30
Journals
|
2
4
6
8
10
12
|
|
|
Knee Surgery, Sports Traumatology, Arthroscopy
11 publications, 17.46%
|
|
|
American Journal of Sports Medicine
9 publications, 14.29%
|
|
|
Orthopaedic Journal of Sports Medicine
9 publications, 14.29%
|
|
|
Journal of Experimental Orthopaedics
5 publications, 7.94%
|
|
|
BMC Musculoskeletal Disorders
4 publications, 6.35%
|
|
|
Arthroscopy - Journal of Arthroscopic and Related Surgery
4 publications, 6.35%
|
|
|
Arthroscopy Techniques
2 publications, 3.17%
|
|
|
JAAOS Global Research and Reviews
1 publication, 1.59%
|
|
|
Current Reviews in Musculoskeletal Medicine
1 publication, 1.59%
|
|
|
European Journal of Orthopaedic Surgery and Traumatology
1 publication, 1.59%
|
|
|
Journal of Clinical Orthopaedics and Trauma
1 publication, 1.59%
|
|
|
Knee
1 publication, 1.59%
|
|
|
Bone and Joint Research
1 publication, 1.59%
|
|
|
Cureus
1 publication, 1.59%
|
|
|
Journal of Orthopaedic Surgery and Research
1 publication, 1.59%
|
|
|
Arthroscopy Sports Medicine and Rehabilitation
1 publication, 1.59%
|
|
|
Medicine (United States)
1 publication, 1.59%
|
|
|
Biomechanics
1 publication, 1.59%
|
|
|
Journal of Bone and Joint Surgery - Series A
1 publication, 1.59%
|
|
|
Journal of ISAKOS
1 publication, 1.59%
|
|
|
Visual Computing for Industry Biomedicine and Art
1 publication, 1.59%
|
|
|
JBJS Case Connector
1 publication, 1.59%
|
|
|
Journal of Knee Surgery
1 publication, 1.59%
|
|
|
2
4
6
8
10
12
|
Publishers
|
2
4
6
8
10
12
14
16
18
20
|
|
|
Springer Nature
19 publications, 30.16%
|
|
|
SAGE
18 publications, 28.57%
|
|
|
Elsevier
11 publications, 17.46%
|
|
|
Wiley
7 publications, 11.11%
|
|
|
Ovid Technologies (Wolters Kluwer Health)
4 publications, 6.35%
|
|
|
British Editorial Society of Bone and Joint Surgery
1 publication, 1.59%
|
|
|
MDPI
1 publication, 1.59%
|
|
|
Georg Thieme Verlag KG
1 publication, 1.59%
|
|
|
2
4
6
8
10
12
14
16
18
20
|
- We do not take into account publications without a DOI.
- Statistics recalculated weekly.