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Increased posterior tibial slope results in increased incidence of posterior lateral meniscal root tears in ACL reconstruction patients

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

While the association with acute anterior cruciate ligament (ACL) tears has been established, other risk factors and associated pathologies which occur with a concomitant lateral meniscal posterior root tear (LMPRT) are not well defined. The purpose of this study was to compare the risk factors and concomitant pathologies between patients with LMPRT and patients without LMPRTs in the setting of a primary ACL tear.

Methods

Patients with a LMPRT identified at the time of primary ACL reconstruction by a single surgeon were identified. These patients were matched by age and sex to patients undergoing primary ACL reconstruction who were not found to have lateral meniscus root tears (control group) in a 1:1 ratio. Lateral posterior tibial slope (PTS), medial PTS, lateral femoral condyle height and depth, lateral tibial plateau depth, and lateral tibial plateau subluxation were measured on MRI. Anteroposterior full-limb alignment radiographs were used to measure the medial proximal tibia angle (MPTA), the mechanical lateral distal femoral angle (mLDFA), and the mechanical weightbearing axis for the injured extremity.

Results

One-hundred three patients were included in both the LMPRT group and the matched control group. Patients with a LMPRT had a significantly steeper lateral PTS (9.1° vs. 7.0°, p = 0.001), a steeper medial PTS (7.0° vs. 6.0°, p = 0.03), and a greater lateral-to-medial slope asymmetry (2.0° vs. 1.0°, p = 0.001). There were no differences in lateral femoral condyle depth or height, lateral tibial plateau depth, lateral tibial plateau subluxation, MPTA, mLDFA, or mechanical weightbearing axis between groups. There was a significantly increased incidence of medial meniscus ramp lesions in patients with lateral meniscus posterior root tears compared with controls (34.0% vs. 15.5%, odds ratio: 2.8, p = 0.002). There were no associations with concomitant ligament injuries, medial meniscus root tears, or non-ramp tears based on case/control grouping.

Conclusion

In conclusion, LMPRTs in the setting of primary ACL injuries were associated with significantly increased lateral and medial PTSs, and increased asymmetry between lateral and medial PTSs. In addition, clinicians should be aware of the increased incidence of concurrent medial meniscal ramp lesions in patients with LMPRTs. Knowledge of these associations helps guide clinical decision-making and counselling of patients in the setting of ACL tears with concomitant LMPRTs.

Level of evidence

IV.

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Funding

Approved by Vail Health Hospital Institutional Review Board: Protocol #2019-11.

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Authors and Affiliations

  1. Campbell Clinic Orthopaedics, University of Tennessee Health Science Center, Memphis, TN, USA

    David Bernholt

  2. Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN, 55435, USA

    Nicholas N. DePhillipo & Robert F. LaPrade

  3. Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway

    Nicholas N. DePhillipo

  4. Steadman Philippon Research Institute, Vail, CO, USA

    Zachary S. Aman & Mitchell I. Kennedy

  5. Beth Israel Lahey Health, Boston, MA, USA

    Brian T. Samuelsen

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  1. David Bernholt
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  2. Nicholas N. DePhillipo
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  4. Brian T. Samuelsen
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  5. Mitchell I. Kennedy
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  6. Robert F. LaPrade
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Correspondence to Robert F. LaPrade.

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Ethical approval was obtained from the Institutional Review Board (IRB) from Vail Health Hospital.

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Bernholt, D., DePhillipo, N.N., Aman, Z.S. et al. Increased posterior tibial slope results in increased incidence of posterior lateral meniscal root tears in ACL reconstruction patients. Knee Surg Sports Traumatol Arthrosc 29, 3883–3891 (2021). https://doi.org/10.1007/s00167-021-06456-4

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  • DOI: https://doi.org/10.1007/s00167-021-06456-4

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