Abstract：Objective This study aims to investigate the measurement of posterior tibial slope (PTS) and its research progress on anterior cruciate ligament (ACL) injury and reconstruction Methods Recent literature related to PTS in ACL injury published from January 2000 to December 2022 were searched in the database of CNKI, Wanfang data, and PubMed. The following keywords were used: "胫骨平台后倾角,""测量,""前交叉韧带,""损伤," and "重建"as well as "posterior tibial slope,""measure,""anterior cruciate ligament,""injure,"and "reconstruction". A total of 574 were obtained, and 47 were finally included in the analysis after excluding those that were inconsistent to the subject, had incomplete text and low quality and level of evidence, and were replicates. The measurement methods of PTS were summarized, and the effect and mechanism of PTS in ACL injury and reconstruction were explored. Results PTS was measured by X-ray, CT, and MRI. X-ray measurement is the simplest and most widely used method, but its measured value is affected by the reference mark and the length of the selected tibial axis. CT and MRI measurements can effectively eliminate the influence of tibial rotation, and the measured value is more accurate; however, their technical difficulty and costs are high. PTS is an anatomic factor in ACL injury. Excessive levels of PTS will cause excessive internal rotation of the knee during movement, thereby accelerating the occurrence of ACL strain and leading to ACL injury. In ACL reconstruction, excessive PTS will affect the surgical effect by inducing the anterior tibial subluxation of the knee joint after reconstruction and influencing graft roof impingement. Conclusion At present, the measurement method of PTS and its standard value have not been standardized. Excessive PTS will lead to the injury of ACL and affect the clinical outcomes of ACL reconstruction. For patients with ACL injury, a suitable method should be selected to measure PTS before conducting appropriate surgery.
尹志文, 田最, 王泽华, 郭子瑊, 陈帅, 向川. 胫骨平台后倾角的测量及其对前交叉韧带损伤及重建影响的研究进展[J]. 中华解剖与临床杂志, 2023, 28(11): 768-772.
Yin Zhiwen, Tian Zui, Wang Zehua, Guo Zijian, Chen Shuai, Xiang Chuan. Research progress on the measurement of posterior tibial slope and its effect on anterior cruciate ligament injury and reconstruction. Chinese Journal of Anatomy and Clinics, 2023, 28(11): 768-772.
李锋, 周利武, 赵建宁. 膝关节前交叉韧带损伤的诊断与治疗进展[J]. 解剖与临床, 2011, 16(5): 437-440. DOI: 10.3969/j.issn.1671-7163.2011.05.031.Li F, Zhou LW, Zhao JN.Progress on diagnosis and treatment in anterior cruciate ligament injury of knee[J].Anatomy and Clinics,2011,16(5):437-440. DOI: 10.3969/j.issn.1671-7163.2011.05.030
[2]
Sonnery-Cottet B, Archbold P, Cucurulo T, et al.The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament[J]. J Bone Joint Surg Br, 2011,93(11):1475-1478. DOI: 10.1302/0301-620X.93B11.26905
[3]
Lee CC, Youm YS, Cho SD, et al.Does posterior tibial slope affect graft rupture following anterior cruciate ligament reconstruction?[J]. Arthroscopy, 2018,34(7):2152-2155. DOI: 10.1016/j.arthro.2018.01.058
[4]
Webb JM, Salmon LJ, Leclerc E, et al.Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient[J]. Am J Sports Med, 2013,41(12):2800-2804. DOI: 10.1177/0363546513503288
[5]
Giffin JR, Vogrin TM, Zantop T, et al.Effects of increasing tibial slope on the biomechanics of the knee[J]. Am J Sports Med, 2004,32(2):376-382. DOI: 10.1177/0363546503258880
[6]
ALJuhani W, Qasim SS, Alsalman M.Variability of the posterior tibial slope in saudis: a radiographic study[J]. Cureus, 2020,12(9):e10699. DOI: 10.7759/cureus.10699
[7]
Zhang Y, Wang J, Xiao J, et al.Measurement and comparison of tibial posterior slope angle in different methods based on three-dimensional reconstruction[J]. Knee, 2014,21(3):694-698. DOI: 10.1016/j.knee.2014.01.008
Utzschneider S, Goettinger M, Weber P, et al.Development and validation of a new method for the radiologic measurement of the tibial slope[J]. Knee Surg Sports Traumatol Arthrosc, 2011,19(10):1643-1648. DOI: 10.1007/s00167-011-1414-3
[10]
Brazier J, Migaud H, Gougeon F, et al.Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees[J]. Rev Chir Orthop Reparatrice Appar Mot, 1996,82(3):195-200
[11]
倪乾坤, 宋关阳, 张志军, 等. 基于不同长度胫骨轴线胫骨平台后倾角测量值的差异比较分析[J].中国运动医学杂志,2021,40(9):681-684. DOI: 10.3969/j.issn.1000-6710.2021.09.001.Ni QK, Song GY, Zhang ZJ, et al.Comparison and analysis of posterior tibial slope measurements based on tibial axes of different lengths[J]. Chin J Sports Med, 2021,40(9):681-684. DOI: 10.3969/j.issn.1000-6710.2021.09.001
[12]
Pangaud C, Laumonerie P, Dagneaux L, et al.Measurement of the posterior tibial slope depends on ethnicity, sex, and lower limb alignment: a computed tomography analysis of 378 healthy participants[J]. Orthop J Sports Med, 2020,8(1):2325967119895258. DOI: 10.1177/2325967119895258
[13]
Kacmaz IE, Er A, Basa CD, et al.Posterior tibial slope and a new morphometric method with multiplanar reconstruction technique in a turkish sample[J]. Cureus, 2021,13(6):e15472. DOI: 10.7759/cureus.15472
[14]
Cinotti G, Sessa P, Ragusa G, et al.Influence of cartilage and menisci on the sagittal slope of the tibial plateaus[J]. Clin Anat, 2013,26(7):883-892. DOI: 10.1002/ca.22118
[15]
Hohmann E, Tetsworth K, Glatt V, et al.The posterior horn of the medial and lateral meniscus both reduce the effective posterior tibial slope: a radiographic MRI study[J]. Surg Radiol Anat, 2021,43(7):1123-1130. DOI: 10.1007/s00276-021-02696-8
[16]
Hudek R, Schmutz S, Regenfelder F, et al.Novel measurement technique of the tibial slope on conventional MRI[J]. Clin Orthop Relat Res, 2009,467(8):2066-2072. DOI: 10.1007/s11999-009-0711-3
[17]
Shelburne KB, Pandy MG, Anderson FC, et al.Pattern of anterior cruciate ligament force in normal walking[J]. J Biomech, 2004,37(6):797-805. DOI: 10.1016/j.jbiomech.2003.10.010
[18]
Meyer EG, Haut RC.Excessive compression of the human tibio-femoral joint causes ACL rupture[J]. J Biomech, 2005,38(11):2311-2316. DOI: 10.1016/j.jbiomech.2004.10.003
[19]
Dejour H, Bonnin M.Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared[J]. J Bone Joint Surg Br, 1994,76(5):745-749
[20]
Bates NA, Nesbitt RJ, Shearn JT, et al.Posterior tibial slope angle correlates with peak sagittal and frontal plane knee joint loading during robotic simulations of athletic tasks[J]. Am J Sports Med, 2016,44(7):1762-1770. DOI: 10.1177/0363546516639303
[21]
Zeng C, Yang T, Wu S, et al.Is posterior tibial slope associated with noncontact anterior cruciate ligament injury?[J]. Knee Surg Sports Traumatol Arthrosc, 2016,24(3):830-837. DOI: 10.1007/s00167-014-3382-x
[22]
Kızılgöz V, Sivrioğlu AK, Ulusoy GR, et al.Posterior tibial slope measurement on lateral knee radiographs as a risk factor of anterior cruciate ligament injury: a cross-sectional study[J]. Radiography (Lond), 2019,25(1):33-38. DOI: 10.1016/j.radi.2018.07.007
[23]
王斌, 徐青镭, 孙磊. 胫骨平台后倾角与非接触性前交叉韧带损伤的相关性[J].中国矫形外科杂志,2015,23(12):1083-1085. DOI: 10.3977/j.issn.1005-8478.2015.12.06.Wang B, Xu QL, Sun L.Correlation between tibial plateau slopes and non-contact injuries of anterior cruciate ligament[J].Orthopedic Journal of China,2015,23(12):1083-1085. DOI: 10.3977/j.issn.1005-8478.2015.12.06
[24]
Shelburne KB, Kim HJ, Sterett WI, et al.Effect of posterior tibial slope on knee biomechanics during functional activity[J]. J Orthop Res, 2011,29(2):223-231. DOI: 10.1002/jor.21242
[25]
Marouane H, Shirazi-Adl A, Hashemi J.Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait[J]. J Biomech, 2015,48(10):1899-1905. DOI: 10.1016/j.jbiomech.2015.04.017
[26]
McLean SG, Oh YK, Palmer ML, et al. The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task[J]. J Bone Joint Surg Am, 2011,93(14):1310-1317. DOI: 10.2106/JBJS.J.00259
[27]
Bates NA, Mejia Jaramillo MC, Vargas M, et al.External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings[J]. Clin Biomech (Bristol, Avon), 2019,61:84-94. DOI: 10.1016/j.clinbiomech.2018.11.010
[28]
Sauer S, Clatworthy M.Editorial commentary: the ratio of tibial slope and meniscal bone angle is a strong predictor for anterior cruciate ligament injury: a steep hill and a shallow speed bump are a hazardous combination[J]. Arthroscopy, 2021,37(5):1610-1611. DOI: 10.1016/j.arthro.2021.02.006
[29]
Tanaka T, Gale T, Nishida K, et al.Posterior tibial slope and meniscal slope correlate with in vivo tibial internal rotation during running and drop jump[J]. Knee Surg Sports Traumatol Arthrosc, 2023,31(6):2366-2373. DOI: 10.1007/s00167-022-07163-4
[30]
倪乾坤, 张辉, 宋关阳, 等. 非接触性前十字韧带损伤初次重建术后失效的危险因素[J].中华骨科杂志,2020,40(7):389-396. DOI: 10.3760/cma.j.cn121113-20200224-00097.Ni QK, Zhang H, Song GY, et al.Risk factors for primary anterior cruciate ligament reconstruction failure[J].Chin J Orthop,2020,40(7):389-396. DOI: 10.3760/cma.j.cn121113-20200224-00097
[31]
Kikuchi N, Kanamori A, Kadone H, et al.Relationship between posterior tibial slope and lower extremity biomechanics during a single-leg drop landing combined with a cognitive task in athletes after ACL reconstruction[J]. Orthop J Sports Med, 2022,10(7):23259671221107931. DOI: 10.1177/23259671221107931
[32]
Song GY, Zhang H, Zhang J, et al.Excessive preoperative anterior tibial subluxation in extension is associated with inferior knee stability after anatomic anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2020,48(3):573-580. DOI: 10.1177/0363546519900158
[33]
Song GY, Zhang H, Zhang J, et al.Greater static anterior tibial subluxation of the lateral compartment after an acute anterior cruciate ligament injury is associated with an increased posterior tibial slope[J]. Am J Sports Med, 2018,46(7):1617-1623. DOI: 10.1177/0363546518760580
[34]
Zhang ZY, Pan XY, Maimaitijiang P, et al.Anterior tibial subluxation measured under a modified protocol is positively correlated with posterior tibial slope: a comparative study of MRI measurement methods[J]. Knee Surg Sports Traumatol Arthrosc, 2022,30(10):3350-3360. DOI: 10.1007/s00167-022-06913-8
[35]
Delaloye JR, Murar J, Vieira TD, et al.Knee extension deficit in the early postoperative period predisposes to cyclops syndrome after anterior cruciate ligament reconstruction: a risk factor analysis in 3633 patients from the santi study group database[J]. Am J Sports Med, 2020,48(3):565-572. DOI: 10.1177/0363546519897064
[36]
Delincé P, Krallis P, Descamps PY, et al.Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: a multifactorial etiopathogenesis[J]. Arthroscopy, 1998,14(8):869-876. DOI: 10.1016/s0749-8063(98)70025-8
[37]
Matsubara H, Okazaki K, Tashiro Y, et al.Intercondylar roof impingement after anatomic double-bundle anterior cruciate ligament reconstruction in patients with knee hyperextension[J]. Am J Sports Med, 2013,41(12):2819-2827. DOI: 10.1177/0363546513505073
[38]
Howell SM, Clark JA.Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement[J]. Clin Orthop Relat Res, 1992,(283):187-195
[39]
Noailles T, Chalopin A, Boissard M, et al.Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: a systematic literature review[J]. Orthop Traumatol Surg Res, 2019,105(7):1401-1405. DOI: 10.1016/j.otsr.2019.07.007
[40]
Song GY, Ni QK, Zheng T, et al.Increased posterior tibial slope is associated with greater risk of graft roof impingement after anatomic anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2021,49(9):2396-2405. DOI: 10.1177/03635465211018859
[41]
Alaia MJ, Kaplan DJ, Mannino BJ, et al.Tibial sagittal slope in anterior cruciate ligament injury and treatment[J]. J Am Acad Orthop Surg, 2021,29(21):e1045-e1056. DOI: 10.5435/JAAOS-D-21-00143
[42]
Marcheggiani Muccioli GM, Fratini S, Cammisa E, et al.Lateral closing wedge high tibial osteotomy for medial compartment arthrosis or overload[J]. Clin Sports Med, 2019,38(3):375-386. DOI: 10.1016/j.csm.2019.02.002
[43]
van Raaij TM, Brouwer RW. Proximal tibial valgus osteotomy: lateral closing wedge[J]. JBJS Essent Surg Tech, 2015,5(4):e26. DOI: 10.2106/JBJS.ST.N.00104
[44]
DePhillipo NN, Kennedy MI, Dekker TJ, et al. Anterior closing wedge proximal tibial osteotomy for slope correction in failed acl reconstructions[J]. Arthrosc Tech, 2019,8(5):e451-e457. DOI: 10.1016/j.eats.2019.01.001
[45]
Dejour D, Saffarini M, Demey G, et al.Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture[J]. Knee Surg Sports Traumatol Arthrosc, 2015,23(10):2846-2852. DOI: 10.1007/s00167-015-3758-6
[46]
Sonnery-Cottet B, Mogos S, Thaunat M, et al.Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2014,42(8):1873-1880. DOI: 10.1177/0363546514534938
[47]
Bosco F, Giustra F, Giai Via R, et al.Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis[J]. Eur J Orthop Surg Traumatol, 2023, 33(6): 2201-2214. DOI: 10.1007/s00590-022-03419-4.
2023, Vol. 28 
