Lateral Tibial Posterior Slope Is Increased in Patients with Early Graft Failure after Anterior Cruciate Ligament Reconstruction

Joshua J. Christensen, Aaron Krych, William M. Engasser, Matthias K. Vanhees, Mark S. Collins, Diane L. Dahm

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure. Hypothesis: An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion. Results: The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P =.012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95% CI, 1.1-2.2) and continued to increase to 2.4 (95% CI, 1.2-5.0) and 3.8 (95% CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure. Conclusion: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.

Original languageEnglish (US)
Pages (from-to)2510-2514
Number of pages5
JournalAmerican Journal of Sports Medicine
Volume43
Issue number10
DOIs
StatePublished - Jan 1 2015

Fingerprint

Anterior Cruciate Ligament Reconstruction
Transplants
Anterior Cruciate Ligament
Magnetic Resonance Imaging
Control Groups
Tibia
Case-Control Studies
Research Design
Odds Ratio

Keywords

  • ACL injury
  • ACL reconstruction
  • geometry
  • revision
  • tibial plateau

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Lateral Tibial Posterior Slope Is Increased in Patients with Early Graft Failure after Anterior Cruciate Ligament Reconstruction. / Christensen, Joshua J.; Krych, Aaron; Engasser, William M.; Vanhees, Matthias K.; Collins, Mark S.; Dahm, Diane L.

In: American Journal of Sports Medicine, Vol. 43, No. 10, 01.01.2015, p. 2510-2514.

Research output: Contribution to journalArticle

Christensen, Joshua J. ; Krych, Aaron ; Engasser, William M. ; Vanhees, Matthias K. ; Collins, Mark S. ; Dahm, Diane L. / Lateral Tibial Posterior Slope Is Increased in Patients with Early Graft Failure after Anterior Cruciate Ligament Reconstruction. In: American Journal of Sports Medicine. 2015 ; Vol. 43, No. 10. pp. 2510-2514.
@article{479dc93d9efd4527a3d9ec59df741e24,
title = "Lateral Tibial Posterior Slope Is Increased in Patients with Early Graft Failure after Anterior Cruciate Ligament Reconstruction",
abstract = "Background: The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure. Hypothesis: An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion. Results: The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P =.012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95{\%} CI, 1.1-2.2) and continued to increase to 2.4 (95{\%} CI, 1.2-5.0) and 3.8 (95{\%} CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure. Conclusion: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.",
keywords = "ACL injury, ACL reconstruction, geometry, revision, tibial plateau",
author = "Christensen, {Joshua J.} and Aaron Krych and Engasser, {William M.} and Vanhees, {Matthias K.} and Collins, {Mark S.} and Dahm, {Diane L.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1177/0363546515597664",
language = "English (US)",
volume = "43",
pages = "2510--2514",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Inc.",
number = "10",

}

TY - JOUR

T1 - Lateral Tibial Posterior Slope Is Increased in Patients with Early Graft Failure after Anterior Cruciate Ligament Reconstruction

AU - Christensen, Joshua J.

AU - Krych, Aaron

AU - Engasser, William M.

AU - Vanhees, Matthias K.

AU - Collins, Mark S.

AU - Dahm, Diane L.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure. Hypothesis: An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion. Results: The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P =.012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95% CI, 1.1-2.2) and continued to increase to 2.4 (95% CI, 1.2-5.0) and 3.8 (95% CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure. Conclusion: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.

AB - Background: The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure. Hypothesis: An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion. Results: The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P =.012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95% CI, 1.1-2.2) and continued to increase to 2.4 (95% CI, 1.2-5.0) and 3.8 (95% CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure. Conclusion: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients.

KW - ACL injury

KW - ACL reconstruction

KW - geometry

KW - revision

KW - tibial plateau

UR - http://www.scopus.com/inward/record.url?scp=84942915067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942915067&partnerID=8YFLogxK

U2 - 10.1177/0363546515597664

DO - 10.1177/0363546515597664

M3 - Article

VL - 43

SP - 2510

EP - 2514

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 10

ER -