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Comparison of Posterior Tibial Slope Measurement Methods Based on 3-Dimensional Reconstruction
Jin-Gyu Kim1,2,3, Min Jung1,4, Kwangho Chung1,5
1Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Orthopaedic Journal of Sports Medicine
|October 2, 2025
Summary
Accurate posterior tibial slope (PTS) measurement is crucial for knee health. Combining lateral radiographs and MRI-derived asymmetry offers improved accuracy for assessing lateral PTS, aiding in anterior cruciate ligament injury and meniscal pathology evaluation.
Area of Science:
- Orthopedics and Sports Medicine
- Radiology and Imaging
- Biomechanics
Background:
- Posterior tibial slope (PTS) is a key factor in knee sagittal balance.
- Elevated PTS is associated with increased risk of anterior cruciate ligament (ACL) injury and meniscal pathology.
- Current imaging modalities for PTS assessment exhibit variability in measurement techniques and reliability.
Purpose of the Study:
- To evaluate the accuracy of lateral plateau slope calculation using lateral radiographs (LR) and MRI-derived asymmetry.
- To compare the reliability and accuracy of different imaging modalities for PTS assessment.
- To determine if 3D reconstruction serves as a consistent and accurate reference for PTS assessment.
Main Methods:
- A cohort study including 32 patients undergoing ACL reconstruction.
- PTS measurements were taken from knee LRs, tibial long-bone LRs (LLRs), preoperative MRI, and 3D CT reconstructions.
- Intra- and interrater reliability were assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots.
Main Results:
- 3D reconstructions showed excellent reliability (ICC, 0.93-0.97).
- LR and LLR demonstrated high intrarater reliability, with LLR showing excellent interrater reliability.
- Combining LLR-based medial PTS with MRI-derived asymmetry improved agreement with 3D lateral tibial plateau (LTP) measurements (ICC, 0.80).
Conclusions:
- Medial PTS measurement via LR and LLR is accurate and consistent.
- MRI-derived lateromedial PTS asymmetry is reliable.
- Combining LLR medial PTS with MRI asymmetry enhances lateral PTS estimation accuracy compared to MRI alone.
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