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. 2017 Feb 13;5(2):2325967116688664.
doi: 10.1177/2325967116688664. eCollection 2017 Feb.

Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

Katherine M Bojicic  1 , Mélanie L Beaulieu  2 , Daniel Y Imaizumi Krieger  3 , James A Ashton-Miller  4 , Edward M Wojtys  5
Affiliations

Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

Katherine M Bojicic et al. Orthop J Sports Med. .

Abstract

Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury.

Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury.

Study design: Case-control study; Level of evidence, 3.

Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System's archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression.

Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%.

Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.

Keywords: ACL; BMI; anatomy; injury prevention; knee; ligament.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this study was provided by United States Public Health Service grant R01 AR054821 and the University of Michigan Medical School Student Biomedical Research Program.

Figures

Figure 1.
Figure 1.
Midsagittal image defined by the presence of the posterior cruciate ligament (PCL) attachment, the intercondylar eminence, and concave anterior and posterior tibial cortex. The tibial longitudinal axis was found by drawing 2 overlapping circles: 1 proximal and 1 distal.
Figure 2.
Figure 2.
Examples of the various knee structural measurements. (A) The posterior tibial slope (PTS) was defined as the difference between 90° and the angle (θ) between the longitudinal axis of the tibia and a line (L1) that connects the superior-anterior and superior-posterior cortices of the proximal tibia. (B) The meniscal bone angle (MBA) was defined as the angle (θ) between L1 and a line (L2) that lies along the superior surface of the wedge-shaped posterior meniscal cartilage. (C) The middle cartilage slope (MCS) was defined as the difference between 90° and the angle (θ) between the longitudinal axis of the tibia and a line (L3) that joins the most superior portions of the anteriorly and posteriorly located prominences of the middle articular cartilage surfaces. (D) The posterior meniscal height (PMH) was defined as the length of a line (L4) parallel to the longitudinal axis of the tibia and connects the top of the posterior meniscal cartilage and the point at which the posterior meniscus intersects the middle articular cartilage.
See this image and copyright information in PMC

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