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An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The posterior tibial slope (PTS) is considered a risk factor for anterior cruciate ligament (ACL) injury. However, the influence of PTS on graft failure following ACL reconstruction remains relatively unknown. Therefore, this systematic review was conducted to investigate whether PTS could be a potential risk factor for graft failure after ACL reconstruction.

Methods

PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, and Wanfang Database were comprehensively searched from inception to March 31, 2021. Observational studies reporting the associations of medial tibial plateau slope (MTPS) or lateral tibial plateau slope (LTPS) with graft failure after ACL reconstruction were evaluated.

Results

Twenty studies involving 12 case–control studies, 4 retrospective studies and 4 cross-sectional studies including 5326 patients met the final inclusion criteria. The high heterogeneity and the characteristics of nonrandomized controlled trials limited data synthesis. Fifteen of the 20 included studies detected a significant association between increased PTS and ACL graft failure, while 5 studies concluded that increased PTS was not associated with ACL graft failure. Ten studies suggested that MTPS is associated with ACL graft failure, and six studies suggested that LTPS is associated with ACL graft failure. The mean MTPS values for nonfailure group ranged from 3.5° ± 2.5° to 14.4° ± 2.8°. For the graft failure group, MTPS ranged from 4.71° ± 2.41° to 17.2° ± 2.2°. The mean LTPS values for nonfailure group ranged from 2.9° ± 2.1° to 11.9° ± 3.0°. For the graft failure group, LTPS ranged from 5.5° ± 3.0° to 13.3° ± 3.0°. The reported PTS values that caused ACL graft failure was greater than 7.4° to 17°.

Conclusion

Based on the current clinical evidence, increased PTS is associated with a higher risk of ACL graft failure after ACL reconstruction. Despite various methods of measuring PTS have high reliability, there is still vast disagreement in the actual value of PTS.

Level of evidence

IV.

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Acknowledgements

The National Natural Science Foundation of China (81874017, 81960403, 82060405, 82060413, and 82160422); Natrual Science Foundation of Gansu Province of China (20JR5RA320, and 21JR7RA393); Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2017-ZD02, CY2017-QN11, CY2020-BJ03, and CY2021-MS-B02); Fundamental Research Funds for the Central Universities (lzujbky-2021-kb30).

Funding

Funding was provided by The National Natural Science Foundation of China (81874017, 81960403, 82060405, 82060413, and 82160422), Natrual Science Foundation of Gansu Province of China (20JR5RA320), Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2017-ZD02, CY2017-QN11, and CY2020-BJ03) and Fundamental Research Funds for the Central Universities (lzujbky-2021-kb30).

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Author notes

  1. Zhongcheng Liu, Jin Jiang, and Qiong Yi contributed equally in this work.

Authors and Affiliations

  1. Department of Orthopaedics, Gansu Key Laboratory of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China

    Zhongcheng Liu, Jin Jiang, Qiong Yi, Yuanjun Teng, Xuening Liu, Jinwen He, Kun Zhang, Lifu Wang, Fei Teng, Bin Geng, Yayi Xia & Meng Wu

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  1. Zhongcheng Liu
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Contributions

We declare that each author (ZL, JJ, QY, YT, XL, JH, KZ, LW, FT, BG, YX, MW) has participated in the following work for this manuscript. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Yayi Xia or Meng Wu.

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This systematic review did not used any human data that belonged to our patients. All of the data was extracted from the previous studies that have been published previously. The registered number of systematic review has been added to the Methods section, which was erased due to the request for reviewing. And the abbreviations of previously erased names have been released in the Methods section.

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Liu, Z., Jiang, J., Yi, Q. et al. An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 2377–2387 (2022). https://doi.org/10.1007/s00167-022-06888-6

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