Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction

Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3717-3723. doi: 10.1007/s00167-018-5004-5. Epub 2018 Jun 4.


Purpose: To investigate the correlation between posterior tibial slope (PTS) and tibial tunnel widening after anterior cruciate ligament reconstruction (ACL-R).

Methods: Twenty-five patients underwent anatomic single-bundle ACL-R using quadriceps tendon autograft. Six months after surgery, each patient underwent high-resolution computed tomography (CT). Tibial tunnel aperture location was evaluated using a grid method. Medial and lateral PTS (°) was measured based on a previously described method. To evaluate tibial tunnel widening, cross-sectional area (CSA) of the tibial tunnel beneath the aperture was measured using CT axial slice. Nominal elliptical area was calculated using the diameter of a dilator during the surgery and the angle between the axial slice and the tunnel axis. Percentage of tunnel widening (%) was determined by dividing the CSA by the nominal area. Pearson correlation coefficient was used to explore the association between medial/lateral PTS and tibial tunnel widening (P < 0.05).

Results: Location of tibial tunnel aperture was 29.8 ± 6.3% in anterior-posterior direction, and 45.7 ± 2.1% in medial-lateral direction. Medial and lateral PTS were 3.7° ± 2.5° and 4.9° ± 2.4° respectively. Tibial tunnel widening was 97.2 ± 20.3%. Tibial tunnel widening was correlated with medial PTS (r = 0.558, P = 0.004) and lateral PTS (r = 0.431, P = 0.031).

Conclusion: Steeper medial and lateral PTS correlated with greater tibial tunnel widening. The clinical relevance is that surgeons should be aware that PTS may affect tibial tunnel widening after ACL-R. Thus, subjects with steeper PTS may need to be more carefully followed to see if there is greater tibial tunnel widening, which might be important especially in revision ACL-R.

Level of evidence: III.

Keywords: ACL; Anterior cruciate ligament reconstruction; Bony morphology; Computed tomography; Cross-sectional area; Posterior tibial slope; Quadriceps tendon graft; Tibial tunnel location; Tunnel widening.

MeSH terms

  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods
  • Female
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Male
  • Quadriceps Muscle / surgery
  • Tendons / transplantation
  • Tibia / diagnostic imaging*
  • Tibia / surgery
  • Tomography, X-Ray Computed
  • Transplantation, Autologous
  • Treatment Outcome
  • Young Adult