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. 2022 Aug 18;12(1):14071.
doi: 10.1038/s41598-022-18442-y.

Influence of posterior tibial slope on sagittal knee alignment with comparing contralateral knees of anterior cruciate ligament injured patients to healthy knees

Yoshiaki Hiranaka  1 , Hirotsugu Muratsu  2 , Masanori Tsubosaka  3 , Tomoyuki Matsumoto  3 , Akihiro Maruo  1 , Hidetoshi Miya  1 , Ryosuke Kuroda  3 , Takehiko Matsushita  3
Affiliations

Influence of posterior tibial slope on sagittal knee alignment with comparing contralateral knees of anterior cruciate ligament injured patients to healthy knees

Yoshiaki Hiranaka et al. Sci Rep. .

Abstract

Posterior tibial slope (PTS) has been known to contribute to anterior-posterior knee stability and play an essential biomechanical role in knee kinematics. This study aimed to investigate the effect of PTS on single-leg standing sagittal knee alignment of the intact knee. This study included 100 patients with unilateral ACL injury knee (ACL injury group, 53 patients) or with the normal knee (control group, 47 patients). The single-leg standing sagittal alignment of the unaffected knees of the ACL injury group and normal knees of the control group were assessed radiographically with the following parameters: knee extension angle (EXT), PTS, PTS to the horizontal line (PTS-H), femoral shaft anterior tilt to the vertical axis (FAT), and tibial shaft anterior tilt to the vertical axis (TAT). PTS was negatively correlated with EXT and positively correlated with TAT. EXT was significantly larger in the ACL injury group, whereas TAT was smaller in the ACL injury group. Patients with larger PTS tend to stand with a higher knee flexion angle by tilting the tibia anteriorly, possibly reducing tibial shear force. Patients with ACL injury tend to stand with larger EXT, i.e., there is less preventive alignment to minimize the tibial shear force.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Procedure for taking the single-leg standing knee radiograph. A lateral-view single-leg standing knee radiograph was taken with the contralateral side of the foot placed on the footstool without weight-bearing.
Figure 2
Figure 2
Measurement of the five radiographic parameters: EXT, PTS, PTS-H, FAT, and TAT. EXT, knee extension angle, with the hyperextended position denoted as a positive value and the flexion position as a negative value; PTS, posterior tibial slope; PTS-H, posterior tibial slope to the horizontal line; FAT, femoral shaft anterior tilt to the vertical axis, with the forward tilt to the perpendicular line as the positive value; TAT, tibial shaft anterior tilt to the vertical axis, with the backward tilt to the perpendicular line as the negative value.
Figure 3
Figure 3
Regression lines for the relationship between the PTS and the other four parameters (EXT, PTS-H, FAT, and TAT). EXT, knee extension angle; PTS, posterior tibial slope; PTS-H, posterior tibial slope to the horizontal line; FAT, femoral shaft anterior tilt to the vertical axis; TAT, tibial shaft anterior tilt to the vertical axis; ACL, anterior cruciate ligament.
Figure 4
Figure 4
Typical lateral-view radiographs of a normal knee with a large PTS, and with a small PTS. The unaffected side of the knees is shown. The patient with a large PTS (left radiograph) was standing with the knee slightly flexed and the proximal tibial surface level to the ground. PTS, posterior tibial slope; PTS-H, posterior tibial slope to the horizontal line; TAT, tibial shaft anterior tilt to the vertical axis; ACL, anterior cruciate ligament.
Figure 5
Figure 5
Typical lateral-view radiographs of an unaffected knee of an ACL-injured patient (left) and a normal knee (right). The unaffected side of the knees is shown. The patient with the ACL injury was standing with the knee hyperextended and with a large posterior slope to the ground, resulting in less anterior knee tilt compared with that of the patient with a normal knee. PTS, posterior tibial slope; PTS-H, posterior tibial slope to the horizontal line; TAT, tibial shaft anterior tilt to the vertical axis; ACL, anterior cruciate ligament.
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