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Measurement of tibial slope using biplanar stereoradiography (EOS®)

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Abstract

Objectives

Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard.

Methods

This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson’s correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings.

Results

The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738–0.883 and 0.870–0.975).

Conclusions

Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.

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Abbreviations

PTS:

Posterior tibial slope

ACL:

Anterior cruciate ligament

CT:

Computed tomography

AP:

Anteroposterior

L:

Lateral

RL:

Right lateral posterior tibial slope

LL:

Left lateral posterior tibial slope

RM:

Right medial posterior tibial slope

LM:

Left medial posterior tibial slope

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Authors and Affiliations

  1. Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil

    Érica Narahashi, Júlio Brandão Guimarães, Alípio Gomes Ormond Filho, Marcelo Astolfi Caetano Nico & Flávio Duarte Silva

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Narahashi, É., Guimarães, J.B., Filho, A.G.O. et al. Measurement of tibial slope using biplanar stereoradiography (EOS®). Skeletal Radiol 53, 1091–1101 (2024). https://doi.org/10.1007/s00256-023-04528-9

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