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S. LUSTIG, A. ELMANSORI, T. LORDING, E. SERVIEN, P. NEYRET
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The medial and lateral PTS are not necessarily
identical in one given knee and differences of as
much as 27° have been reported in cadaveric
studies [14]. An increased lateral tibial slope
relative to the medial tibial slope can influence
dynamic landing biomechanics by coupling
knee abduction with internal tibial rotation [12].
Various models for PTS measurement on
conventional lateral radiographs have been
described, however it is still imprecise. As a
consequence of superimposition, the lateral
tibial plateau is difficult to identify and separate
assessment of the plateaus is not reliably
possible on lateral radiographs [14].
Previous studies have validated different
radiographic methods for measuring posterior
tibial slope [12]. No significant difference
exists between radiographs, computed tomo
graphy, and magnetic resonance imaging
(MRI); recent work has focused on MRI [12].
Although lateral radiographs are better to
assess the medial PTS, they are inadequate for
reliable and separate PTS and MS assessment.
Therefore, it’s recommended to use conven
tional MRI scans of the knee, because they
allow simple assessment of each plateau
separately and provide the possibility to assess
the MS reliably [6] and methods using three-
dimensional computed reconstructions are
time-consuming and complex [15].
One of the greatest strengths of using MRI for
this application is the ability to visualize the
surface geometry of the articular cartilage.
Because this represents the functional point of
tibiofemoral articulation and is not visible on
radiographs, it permits visualization and
measurement of the separate compartments
and their associated tissue structures [13].
The effects of patient demographics, such as
gender and age, on tibial slope have not been
fully elucidated. Females are at greater risk of
noncontact ACL injury and a steeper tibial
slope has been observed in females [13].
Multiple studies showed that women have a
greater propensity for ACL injury compared to
their male counterparts [3, 4, 6, 20, 21].
It has been suggested that a possible risk factor
for this observation is that women have a nar
rower notch than men and even smaller ACLs.
Gender-and age-specific assessments of the
STS and BS could be important and may
explain the difference in the incidence of
anterior cruciate ligament rupture between
individuals, as well as differences in function
following high tibial osteotomies [13].
The soft tissues (e.g. cartilage and meniscus)
may influence tibial slope and consequently
play a role in antero-posterior stability of the
knee joint. The posterior horn of the menisci is
thicker than the anterior one, and this could
decrease the postero-distal slope [16].
The aims of this study were to evaluate the
correlation between the tibial slope and the non
contact ACL – injury using MRI, as well as to
determine the effects the menisci on tibial
slope. It was hypothesized that the meniscus
would reduce the differences in slope between
the medial and lateral compartments of the
same knee. In addition, it was hypothesized
that the presence of meniscus would correct the
bony inclination of the tibial slope towards the
horizontal.
SUBJECTS AND METHOD
A large group from the Croix-Rousse Hospital
in Lyon city was followed from January 2012
to December 2015. The patients were accepted
for knee interventions; none were diagnosed
with gonarthrosis. Two groups of patients were
established. The examined group consisted of
100 patients (67 male & 33 female) with
isolated complete or partial ruptures of the
ACL injury with age group 18-63 (Mean ± SD,
33.76 ± 10.81). The control group consisted of
100 patients whose major complaint was
patella-femoral pain and their MRIs reveled
intact ACL (52 male & 48 female) and their
ages were ranged from 18-86 (Mean ± SD,
43.65 ± 15.96).
Approval was obtained from the ethics
committee of the medical institution at which
the patients were treated.