Posterior tibial slope correlated with metaphyseal inclination more than metaphyseal height

Excessive posterior tibial slope (PTS) is an independent risk factor for anterior cruciate ligament reconstruction (ACLR) failure, but it remains unclear how PTS relates to other proximal tibial morphologic parameters. The purpose of this study was to analyse sagittal tibial metaphysis morphology, and to calculate the correlation coefficients of PTS with anatomical features.

The authors retrospectively reviewed lateral radiographs of 350 patients that were scheduled to receive primary ACLR to digitize 15 landmarks on the patella, femur, fibula, and tibia, and measure PTS, patellar height, as well as metaphysis height and inclination. Pearson correlation coefficients (r) were computed to assess the linear relationship of PTS with other parameters.

The PTS was 9.8 ± 3.1° (mid-shaft axis), anterior metaphyseal height and inclination was 30.9 ± 4.6 mm and 33.9 ± 7.2°, and posterior metaphyseal height and inclination was 16.1 ± 4.0 mm and 22.0 ± 5.8°. PTS had a low correlation with anterior (r, 0.225) and posterior metaphyseal heights (r, -0.183). PTS had moderate correlations with anterior (r, 0.385) and posterior metaphysis inclination (r, 0.417).

PTS has a low correlation with anterior metaphyseal height, but a moderate correlation with anterior and posterior metaphyseal inclination. The moderate correlation between PTS and metaphysis inclination sheds light on the origin of the deformity, and knees with higher PTS are therefore likely to have metaphyses with greater posterior inclinations. The clinical relevance of these findings is that tibial deflexion osteotomy techniques should attempt to address the underlying deformity of excessive PTS by adjusting metaphyseal inclination rather than making diaphyseal resections.