In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: A systematic review and meta-analysis

Samuel C. Wordeman, Carmen E. Quatman, Christopher C. Kaeding, Timothy Hewett

Research output: Contribution to journalReview article

60 Citations (Scopus)

Abstract

Background: In vivo studies reporting tibial plateau slope as a risk factor for anterior cruciate ligament (ACL) injury have been published with greatly increasing frequency. Purpose: To examine and summarize the in vivo evidence comparing tibial slope in ACL-injured and uninjured populations. Study Design: Systematic review and meta-analysis. Methods: We reviewed publications in Scopus, SPORTDiscus, CINAHL, and PubMed to identify all studies reporting a measure of tibial plateau slope between ACL-injured groups and controls. A meta-analysis was performed including calculation of effect size and 95% confidence interval as well as 95% confidence intervals for the mean values of the measurement in each study. Results: Fourteen studies met our inclusion/exclusion criteria. Five of 6 radiographic studies reporting medial tibial plateau slope (MTPS) demonstrated significant differences between controls and ACL-injured groups, while only 1 of 7 magnetic resonance imaging (MRI) studies reported significant differences between groups. Mean MTPS measurements and standard deviations reported for controls ranged from 2.9 ± 2.8 anterior to 9.5 ± 3 posterior. For ACL-injured patients, MTPS ranged from 1.8 ± 3.5 anterior to 12.1 ± 3.3 posterior. Lateral tibial plateau slope (LTPS) was reported to be significantly greater in ACL-injured groups in all 5 MRI-based studies reporting group comparisons. Mean values for LTPS in controls ranged from 0.3 ± 3.6 anterior slope to 9 ± 4 posterior slope. In ACL-injured groups, mean reported LTPS values ranged from 1.8 ± 3.2 to 11.5 ± 3.54 posterior slope. Conclusion: Despite high measures of reliability for the various methods reported in current studies, there is vast disagreement regarding the actual values of the slope that would be considered "at risk." Reported tibial slope values for control groups vary greatly between studies. In many cases, the study-to-study differences in "normal" tibial slope exceed the difference between controls and ACL-injured patients. The clinical utility of imaging-based measurement methods for the determination of ACL injury risk requires more reliable techniques that demonstrate consistency between studies.

Original languageEnglish (US)
Pages (from-to)1673-1681
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume40
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament
Meta-Analysis
Magnetic Resonance Imaging
Confidence Intervals
Control Groups
Anterior Cruciate Ligament Injuries
PubMed
Publications
Population

Keywords

  • ACL risk factors
  • anterior cruciate ligament
  • noncontact injury
  • tibial slope

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury : A systematic review and meta-analysis. / Wordeman, Samuel C.; Quatman, Carmen E.; Kaeding, Christopher C.; Hewett, Timothy.

In: American Journal of Sports Medicine, Vol. 40, No. 7, 07.2012, p. 1673-1681.

Research output: Contribution to journalReview article

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abstract = "Background: In vivo studies reporting tibial plateau slope as a risk factor for anterior cruciate ligament (ACL) injury have been published with greatly increasing frequency. Purpose: To examine and summarize the in vivo evidence comparing tibial slope in ACL-injured and uninjured populations. Study Design: Systematic review and meta-analysis. Methods: We reviewed publications in Scopus, SPORTDiscus, CINAHL, and PubMed to identify all studies reporting a measure of tibial plateau slope between ACL-injured groups and controls. A meta-analysis was performed including calculation of effect size and 95{\%} confidence interval as well as 95{\%} confidence intervals for the mean values of the measurement in each study. Results: Fourteen studies met our inclusion/exclusion criteria. Five of 6 radiographic studies reporting medial tibial plateau slope (MTPS) demonstrated significant differences between controls and ACL-injured groups, while only 1 of 7 magnetic resonance imaging (MRI) studies reported significant differences between groups. Mean MTPS measurements and standard deviations reported for controls ranged from 2.9 ± 2.8 anterior to 9.5 ± 3 posterior. For ACL-injured patients, MTPS ranged from 1.8 ± 3.5 anterior to 12.1 ± 3.3 posterior. Lateral tibial plateau slope (LTPS) was reported to be significantly greater in ACL-injured groups in all 5 MRI-based studies reporting group comparisons. Mean values for LTPS in controls ranged from 0.3 ± 3.6 anterior slope to 9 ± 4 posterior slope. In ACL-injured groups, mean reported LTPS values ranged from 1.8 ± 3.2 to 11.5 ± 3.54 posterior slope. Conclusion: Despite high measures of reliability for the various methods reported in current studies, there is vast disagreement regarding the actual values of the slope that would be considered {"}at risk.{"} Reported tibial slope values for control groups vary greatly between studies. In many cases, the study-to-study differences in {"}normal{"} tibial slope exceed the difference between controls and ACL-injured patients. The clinical utility of imaging-based measurement methods for the determination of ACL injury risk requires more reliable techniques that demonstrate consistency between studies.",
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AU - Kaeding, Christopher C.

AU - Hewett, Timothy

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N2 - Background: In vivo studies reporting tibial plateau slope as a risk factor for anterior cruciate ligament (ACL) injury have been published with greatly increasing frequency. Purpose: To examine and summarize the in vivo evidence comparing tibial slope in ACL-injured and uninjured populations. Study Design: Systematic review and meta-analysis. Methods: We reviewed publications in Scopus, SPORTDiscus, CINAHL, and PubMed to identify all studies reporting a measure of tibial plateau slope between ACL-injured groups and controls. A meta-analysis was performed including calculation of effect size and 95% confidence interval as well as 95% confidence intervals for the mean values of the measurement in each study. Results: Fourteen studies met our inclusion/exclusion criteria. Five of 6 radiographic studies reporting medial tibial plateau slope (MTPS) demonstrated significant differences between controls and ACL-injured groups, while only 1 of 7 magnetic resonance imaging (MRI) studies reported significant differences between groups. Mean MTPS measurements and standard deviations reported for controls ranged from 2.9 ± 2.8 anterior to 9.5 ± 3 posterior. For ACL-injured patients, MTPS ranged from 1.8 ± 3.5 anterior to 12.1 ± 3.3 posterior. Lateral tibial plateau slope (LTPS) was reported to be significantly greater in ACL-injured groups in all 5 MRI-based studies reporting group comparisons. Mean values for LTPS in controls ranged from 0.3 ± 3.6 anterior slope to 9 ± 4 posterior slope. In ACL-injured groups, mean reported LTPS values ranged from 1.8 ± 3.2 to 11.5 ± 3.54 posterior slope. Conclusion: Despite high measures of reliability for the various methods reported in current studies, there is vast disagreement regarding the actual values of the slope that would be considered "at risk." Reported tibial slope values for control groups vary greatly between studies. In many cases, the study-to-study differences in "normal" tibial slope exceed the difference between controls and ACL-injured patients. The clinical utility of imaging-based measurement methods for the determination of ACL injury risk requires more reliable techniques that demonstrate consistency between studies.

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