Background:Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries.Hypothesis/Purpose:The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury.Study Design:Cohort study; Level of evidence, 3.Methods:The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging–confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient.Results:Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age ( P = .90), sex ( P > .99), or body mass index ( P = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; P = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; P = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; P = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability.Conclusion:PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.

中文翻译：

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胫骨后坡度减小及其与儿童后十字韧带损伤的关系

背景：最近的成人研究表明，胫骨后坡角（PTSA）减小可能是后交叉韧带（PCL）损伤的危险因素。然而，尚无研究调查儿科人群中的这种现象。鉴于最近运动竞赛/专业化和运动相关损伤的增加，了解儿科人群中 PCL 损伤的危险因素非常重要。 假设/目的：本研究的目的是比较原发性 PCL 撕裂儿童患者与患有原发性 PCL 撕裂的儿科患者之间的 PTSA年龄和性别匹配的对照。据推测，与对照组相比，遭受 PCL 撕裂的儿科患者的 PTSA 会降低，PTSA 降低与 PCL 损伤的几率较高相关。证据级别，3。方法：对 2006 年至 2021 年间在 1 级儿科创伤中心遭受 PCL 损伤的所有患者的记录进行了审查。年龄≤18岁且经磁共振成像证实PCL撕裂的患者被纳入研究。排除同时存在前交叉韧带撕裂、既往 PCL 重建或冠状面重新对准的患者。根据年龄和性别对对照组进行匹配，磁共振成像扫描显示其韧带完好无损。 PTSA 通过受伤膝盖或胫骨的侧位 X 光片进行测量。比较队列之间的平均 PTSA，并根据文献中描述的正常斜率范围 (7°-10°)、上限范围 (>10°) 和下限范围 (<7°) 计算优势比。通过计算组内相关系数来确定评估者间和评估者内的可靠性。 结果：在本研究期间遭受 PCL 损伤的 98 名患者中，59 名 (60%) 符合纳入标准，并匹配了 59 名健康膝关节对照。队列之间的年龄 (P = .90)、性别 (P > .99) 或体重指数 (P = .74) 没有差异。与对照组相比，PCL 队列的平均 ± SD PTSA 较低（5.9°± 2.7° vs 7.3°± 4.3°；P = .03）。 PTSA <7° 与 PCL 撕裂风险的 2.8 (95% CI, 1.3-6.0; P = .01) 倍相关。相反，PTSA >10° 与 PCL 撕裂风险的 0.27 (95% CI, 0.09-0.81; P = .02) 倍相关。这些 PTSA 测量结果显示了可接受的评估者内和评估者间可靠性。结论：PTSA <7° 与儿科人群中 PCL 损伤几率增加相关，而斜率 >10° 与 PCL 损伤几率降低相关。这些发现证实了成人研究中的类似结果；然而，需要进一步的研究来阐明 PTSA 作为 PCL 损伤的危险因素。