Background:

There is evidence that tibial slope may play a role in revision risk after anterior cruciate ligament reconstruction (ACLR); however, prior studies are inconsistent.

Purpose:

To determine (1) whether there is a difference in lateral tibial posterior slope (LTPS) or medial tibial posterior slope (MTPS) between patients undergoing revised ACLR and those not requiring revision and (2) whether the medial-to-lateral slope difference is different between these 2 groups.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We conducted a matched case-control study (2006-2015). Cases were patients aged ≤21 years who underwent revision surgery after primary unilateral ACLR; controls were patients aged ≤21 years without revision who were identified from the same source population. Controls were matched to cases by age, sex, body mass index, race, graft type, femoral fixation device, and post-ACLR follow-up time. Tibial slope measurements were made by a single blinded reviewer using magnetic resonance imaging. The Wilcoxon signed rank test and McNemar test were used for continuous and categorical variables, respectively.

Results:

No difference was observed between revised and nonrevised ACLR groups for LTPS (median: 6° vs 6°, P = .973) or MTPS (median: 4° vs 5°, P = .281). Furthermore, no difference was found for medial-to-lateral slope difference (median: −1 vs −1, P = .289). A greater proportion of patients with revised ACLR had an LTPS ≥12° (7.6% vs 3.8%) and ≥13° (4.7% vs 1.3%); however, this was not statistically significant after accounting for multiple testing.

Conclusion:

We failed to observe an association between revision ACLR surgery and LTPS, MTPS, or medial-to-lateral slope difference. However, there was a greater proportion of patients in the revision ACLR group with an LTPS ≥12°, suggesting that a minority of patients who have more extreme values of LTPS have a higher revision risk after primary ACLR. A future cohort study evaluating the angle that best differentiates patients at highest risk for revision is needed.

中文翻译：

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≤21岁患者的胫骨坡度与修订前交叉韧带重建之间的关联：一项包括317次修订的病例对照研究。

背景：

有证据表明，胫骨前交叉韧带重建（ACLR）后，胫骨坡度可能在翻修风险中起作用。但是，先前的研究并不一致。

目的：

确定（1）接受修订ACLR的患者和不需要修订的患者之间胫骨后外侧倾斜度（LTPS）或胫骨内侧后倾斜度（MTPS）是否存在差异；以及（2）内侧至外侧倾斜度差异是否为这两组之间的差异。

学习规划：

病例对照研究；证据水平3。

方法：

我们进行了匹配的病例对照研究（2006-2015年）。病例为≤21岁的患者，他们接受了原发性单侧ACLR后的翻修手术；对照是≤21岁且未经修订的患者，这些患者均来自同一来源人群。对照根据年龄，性别，体重指数，种族，移植物类型，股骨固定装置和ACLR后的随访时间与病例相匹配。胫骨斜率的测量是由一个单盲检查者使用磁共振成像进行的。Wilcoxon符号秩检验和McNemar检验分别用于连续变量和分类变量。

结果：

LTPS（中位数：6°vs 6°，P = .973）或MTPS（中位数：4°vs 5°，P = .281）在经修订和未经修订的ACLR组之间未观察到差异。此外，没有发现内侧到外侧的坡度差异（中位数：-1 vs -1，P = .289）。修正ACLR的患者中，LTPS≥12°（7.6％vs.3.8％）和≥13°（4.7％vs 1.3％）的比例更大。但是，考虑到多次测试后，这在统计上并不显着。

结论：

我们未能观察到修订版ACLR手术与LTPS，MTPS或内侧至外侧坡度差异之间的关联。但是，修订版ACLR组中LTPS≥12°的患者比例更高，这表明少数具有LTPS极值的患者在原发ACLR后有更高的修订风险。需要进行一项未来的队列研究，以评估能够最大程度地区分高翻修风险患者的角度。