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Increased Medial Posterior Tibial Slope Is Associated With Worse Patient-Reported Outcomes After Bicruciate Ligament
Kun-Han Lee1, Kun-Hui Chen1,2, Ya-Wen Tsai1,2
1Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
Purpose:
To evaluate the influence of medial and lateral posterior tibial slopes (MPTS and LPTS) on graft survival and patient-reported outcomes (PROs) in patients undergoing bicruciate ligament reconstruction for multiligament knee injuries.
Methods:
This retrospective study included patients who underwent bicruciate ligament reconstruction between January 2010 and December 2022. Eligible patients were ≥20 years old and had a minimum of 2 years of clinical follow-up, whereas those with pre-existing disability, concomitant tibial plateau, distal femoral, or patellar fractures, or knee dislocation grade V or VI at the time of injury were excluded. MPTS and LPTS were measured on magnetic resonance imaging, and patients were stratified by previously reported slope thresholds (MPTS > 5.6°, LPTS > 3.8° or >7.4°). Graft failure and PROs, including International Knee Documentation Committee score, Tegner activity scale, Lysholm score, and visual analog scale were recorded and analyzed.
Results:
Of the 77 patients who underwent bicruciate reconstruction, 50 met the inclusion criteria and were analyzed. The mean follow-up was 8.8 ± 7.7 years. Graft failure occurred in 8 patients (16.0%), including 4 anterior cruciate ligament retears, 2 posterior cruciate ligament retears, and 2 cases of graft laxity. No significant differences in graft failure or PROs were observed between groups stratified by MPTS or LPTS thresholds. However, MPTS showed a significant negative correlation with International Knee Documentation Committee (rs = -0.386, P = .006), Lysholm (rs = -0.290, P = .041), and Tegner activity scores (rs = -0.282, P = .047), indicating worse functional outcomes with higher MPTS. No significant correlations were found between LPTS and any PROs.
Conclusions:
Graft failure rates did not differ according to MPTS or LPTS. However, a higher MPTS was associated with lower International Knee Documentation Committee, Lysholm, and Tegner activity scores in linear regression analyses, indicating poorer functional outcomes following bicruciate ligament reconstruction.
Level Of Evidence:
Level IV, retrospective case series.
