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Steep lateral tibial slope measured on magnetic resonance imaging is the best radiological predictor of anterior cruciate ligament reconstruction failure

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify the radiological predictive risk factors for anterior cruciate ligament reconstruction (ACLR) failure, compare the diagnostic accuracies of different parameters of conventional radiographs and magnetic resonance imaging (MRI), and determine the cutoff values for patients at higher risk.

Methods

Twenty-eight patients who were diagnosed as ACLR failure via MRI or arthroscopic examination were included in the study group. They were matched to 56 patients who underwent primary ACLR with the same surgical technique and without graft failure at the minimum 24-month follow-up by age, sex, and body mass index. On true lateral whole-leg radiographs, the posterior tibial slope (PTS) referenced to the tibial mechanical axis (PTS-mechanical), PTS referenced to the tibial proximal anatomical axis (PTS-anatomical), and anterior tibial translation (ATT) were measured. On the sagittal slices of MRI, the medial tibial slope (MTS), medial tibial plateau (MTP) subluxation (MTPsublx), lateral tibial slope (LTS), and lateral tibial plateau (LTP) subluxation (LTPsublx) were obtained. Receiver operator characteristic (ROC) curves were constructed to compare the diagnostic performance and determine the cutoff values of different radiological parameters.

Results

The study group demonstrated higher values of PTS-mechanical (10.7° ± 2.9° vs 8.7° ± 1.9°, p = 0.003), PTS-anatomical (13.2° ± 2.8° vs 10.5° ± 2.5°, p < 0.001), ATT (10.7 ± 3.3 mm vs 8.9 ± 2.2 mm, p = 0.014), LTS (9.4° ± 2.1° vs 5.5° ± 2.5°, p < 0.001), and LTPsublx (8.2 ± 2.8 mm vs 6.8 ± 1.9 mm, p = 0.009) as compared with the control group. The area under the ROC curve of LTS was significantly larger than that of PTS-mechanical (p = 0.006) and PTS-anatomical (p = 0.020). Based on the maximum Youden indexes, the cutoff values of PTS-mechanical, PTS-anatomical, and LTS were 10.1° (sensitivity, 64.3%; specificity, 78.6%), 12.0° (sensitivity, 71.4%; specificity, 71.4%), and 7.7° (sensitivity, 85.7%; specificity, 80.4%), respectively.

Conclusion

Due to the morphological asymmetry of the MTP and LTP, steep LTS measured on MRI is the best radiological predictor of ACLR failure. Detailed measurement of the LTS on MRI is recommended to evaluate the risk of ACLR failure prior to the surgery.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ATT:

Anterior tibial translation

AUC:

Area under the curve

BMI:

Body mass index

CI:

Confidence interval

FTA:

Femur–tibia angle

HKA:

Hip–knee–ankle angle

ICC:

Interclass correlation coefficient

LARS:

Ligament advanced reinforcement system

LTH:

Lateral tibial height

LTP:

Lateral tibial plateau

LTPsublx:

Lateral tibial plateau subluxation

LTS:

Lateral tibial slope

MCL:

Medial collateral ligament

MRI:

Magnetic resonance imaging

MRI-TA:

Tibial axis on magnetic resonance imaging

MTD:

Medial tibial depth

MTP:

Medial tibial plateau

MTPsublx:

Medial tibial plateau subluxation

MTS:

Medial tibial slope

PCL:

Posterior cruciate ligament

PLC:

Knee posterolateral corner

PTS:

Posterior tibial slope

PTS-anatomical:

Posterior tibial slope referenced to the tibial proximal anatomical axis

PTS-mechanical:

Posterior tibial slope referenced to the tibial mechanical axis

ROC:

Receiver operating characteristic

SD:

Standard deviation

TMA:

Tibial mechanical axis

TPAA:

Tibial proximal anatomical axis

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Funding

(1) National Key Research and Development Program of China (2018YFC1106200, 2018YFC1106202) [**zhong Zhao]; (2) Natural Science Foundation of Shanghai (19ZR1438500, 20S31900700) [Shikui Dong]. The funding source did not play a role in the investigation.

Author information

Author notes

  1. Zipeng Ye, Junjie Xu and Jiebo Chen contributed equally to the work.

Authors and Affiliations

  1. Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, China

    Zipeng Ye, Junjie Xu, Jiebo Chen, Yi Qiao, Chenliang Wu, Guoming **e, Shikui Dong & **zhong Zhao

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  1. Zipeng Ye
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  2. Junjie Xu
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  3. Jiebo Chen
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  6. Guoming **e
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  7. Shikui Dong
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  8. **zhong Zhao
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Contributions

ZY: Conceptualization; investigation; formal analysis; writing—original draft. JX and JC: Conceptualization; methodology; writing—original draft. YQ and CW: Investigation; data curation. GX and SD: Methodology; formal analysis; supervision. JZ: Conceptualization; supervision; writing—review and editing.

Corresponding authors

Correspondence to Guoming **e, Shikui Dong or **zhong Zhao.

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The authors declare that they have no competing interest.

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Approved by the Ethics Committee of Shanghai Sixth People’s Hospital (Approval No: 2016-111; date of review: 2016-10-26).

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Ye, Z., Xu, J., Chen, J. et al. Steep lateral tibial slope measured on magnetic resonance imaging is the best radiological predictor of anterior cruciate ligament reconstruction failure. Knee Surg Sports Traumatol Arthrosc 30, 3377–3385 (2022). https://doi.org/10.1007/s00167-022-06923-6

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