Commentary & Perspective

Steeper Tibial Slopes, Like Steeper Ski Slopes, Might Lead to More ACL Stress and Tears

Commentary on an article by Dean Wang, MD, et al.: “Tibiofemoral Kinematics During Compressive Loading of the ACL-Intact and ACL-Sectioned Knee. Roles of Tibial Slope, Medial Eminence Volume, and Anterior Laxity”

Robert F. LaPrade, MD, PhD

Examining the associations between differing knee osseous geometries and knee kinematics during loading provides an important step toward the broader understanding of what causes anterior cruciate ligament (ACL) tears. In this study involving compressive loading of cadaveric knees, Wang et al. found that differences in osseous geometries were predictive of changes in anterior tibial translation and internal tibial rotation. In addition, different portions of the osseous geometry affected the ACLintact and ACL-sectioned conditions differently. For the ACL-intact condition, increased anterior tibial translation correlated with the sagittal-plane tibial slope of both compartments as well as the difference in slope (slope differential) between each compartment. Internal tibial rotation, which would be important during the pivot-shift mechanism, correlated with increased lateral-compartment sagittal slope and the slope differential. For the ACL-sectioned condition, the volume of the anteromedial portion of the medial tibial eminence and the amount of anterior translation during a simulated Lachman test were more related to knee kinematics.

Read full Article: Steeper Tibial Slopes, Like Steeper Ski Slopes, Might Lead to More ACL Stress and Tears.  JBJS in Vol. 101, No. 12, June 19, 2019