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Low posterior tibial slope is associated with increased risk of PCL graft failure

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the effect of posterior tibial slope (PTS) on patient-reported outcomes (PROs) and posterior cruciate ligament (PCL) graft failure after PCL reconstruction.

Methods

Patients undergoing PCL reconstruction with a minimum 2-year follow-up were included in this retrospective cohort study. A chart review was performed to collect patient-, injury-, and surgery-related data. Medial PTS was measured on preoperative lateral radiographs. Validated PROs, including the International Knee Documentation Committee Subjective Knee Form, Knee injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, and Visual Analogue Scale for pain, were collected at final follow-up. A correlation analysis was conducted to assess the relationship between PTS and PROs. A logistic regression model was performed to evaluate if PTS could predict PCL graft failure.

Results

Overall, 79 patients with a mean age of 28.6 ± 11.7 years and a mean follow-up of 5.7 ± 3.3 years were included. After a median time from injury of 4.0 months, isolated and combined PCL reconstruction was performed in 22 (28%) and 57 (72%) patients, respectively. There were no statistically significant differences in PROs and PTS between patients undergoing isolated and combined PCL reconstruction (non-significant [n.s.]). There were no significant correlations between PTS and PROs (n.s.). In total, 14 (18%) patients experienced PCL graft failure after a median time of 17.5 months following PCL reconstruction. Patients with PCL graft failure were found to have statistically significantly lower PTS than patients without graft failure (7.0 ± 2.3° vs. 9.2 ± 3.3°, p < 0.05), while no differences were found in PROs (n.s.). PTS was shown to be a significant predictor of PCL graft failure, with a 1.3-fold increase in the odds of graft failure for each one-degree reduction in PTS (p < 0.05).

Conclusions

This study showed that PTS does not affect PROs after PCL reconstruction, but that PTS represents a surgically modifiable predictor of PCL graft failure.

Level of evidence

III.

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Funding

No funding was received for the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA

    Philipp W. Winkler, Nyaluma N. Wagala, Sabrina Carrozzi, Ehab M. Nazzal, Michael A. Fox, Jonathan D. Hughes, Bryson P. Lesniak, Dharmesh Vyas, Stephen J. Rabuck, James J. Irrgang & Volker Musahl

  2. Department for Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Philipp W. Winkler

  3. Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Suite 210, 100 Technology Drive, Pittsburgh, PA, 15219, USA

    James J. Irrgang

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  1. Philipp W. Winkler
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  2. Nyaluma N. Wagala
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Contributions

All listed authors have contributed substantially to this work: PWW, NNW, MF, EMN, SC, and JDH collected data, and performed statistical analysis, literature review, and primary manuscript preparation. VM, BPL, DV, SR, and JJI assisted with interpretation of the results as well as editing and final manuscript preparation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Philipp W. Winkler.

Ethics declarations

Conflict of interest

VM reports educational grants, consulting fees, and speaking fees from Smith & Nephew plc, educational grants from Arthrex, is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and Deputy Editor-in-Chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). DV reports consulting fees from Arthrex and is a member of the editorial board of The American Journal of Sports Medicine.

Ethical approval

This study was approved by the Institutional Review Board of the University of Pittsburgh (No.: STUDY20070271).

Informed consent

Written informed consent was obtained from each patient who completed the questionnaire of this study.

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The investigation was performed at the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.

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Winkler, P.W., Wagala, N.N., Carrozzi, S. et al. Low posterior tibial slope is associated with increased risk of PCL graft failure. Knee Surg Sports Traumatol Arthrosc 30, 3277–3286 (2022). https://doi.org/10.1007/s00167-021-06760-z

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