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Variability Between Full-Length Lateral Radiographs and Standard Short Knee Radiographs When Evaluating Posterior Tibial Slope in Revision ACL Patients: Response.

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Variability Between Full-Length Lateral Radiographs and Standard Short Knee Radiographs When Evaluating Posterior

Alfred A Mansour1, Joshua Steward1, Ryan J Warth1

  • 1Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.

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Summary

Full-length lateral radiographs provide more reliable posterior tibial slope measurements than standard short knee views in patients with failed anterior cruciate ligament reconstruction. This is crucial for accurate assessment and surgical planning in revision cases.

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Biomechanics

Background:

  • Increased posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) reconstruction failure.
  • Accurate PTS measurement is vital for revision ACL surgery outcomes.
  • Conflicting reports exist regarding PTS measurements between standard short knee (SSK) and full-length lateral (FLL) radiographs.

Purpose of the Study:

  • To compare PTS measurements between SSK and FLL radiographs in patients with failed primary ACL reconstruction.
  • To investigate the variability of PTS measurements using different radiographic techniques.

Main Methods:

  • A cohort study of 33 patients with failed primary ACL reconstructions was conducted.
  • Medial and lateral PTS were measured on both SSK and FLL radiographs by two independent observers.
  • Inter- and intraobserver reliability were assessed using the intraclass correlation coefficient (ICC).

Main Results:

  • Excellent inter- and intraobserver reliability was achieved for PTS measurements.
  • FLL radiographs showed significantly higher mean PTS on both medial (12.5°± 4.6°) and lateral (12.2°± 4°) plateaus compared to SSK (11.2°± 5.3° and 10.7°± 4.3°, respectively).
  • A significant difference (≥2°) in absolute PTS measurements was observed in 66.67% of medial plateau assessments, with variability up to 8.5°.

Conclusions:

  • SSK and FLL radiographs yield non-interchangeable PTS measurements in patients with failed ACL reconstruction.
  • FLL radiographs exhibit less variability and are recommended for evaluating these complex cases.
  • Utilizing FLL radiographs can improve the accuracy of PTS assessment in revision ACL surgery planning.