The radiographic tibial spine area is correlated with the occurrence of ACL injury

Abstract

Purpose: The purpose of this study was to reveal the possible influence of the tibial spine area on the occurrence of ACL injury.

Methods: Thirty-nine subjects undergoing anatomical ACL reconstruction (30 female, 9 male: average age 29 ± 15.2) and 37 subjects with intact ACL (21 female, 16 male: average age 29 ± 12.5) were included in this study. In the anterior-posterior (A-P) and lateral knee radiograph, the tibial spine area was measured using a PACS system. In axial knee MRI exhibiting the longest femoral epicondylar length, the intercondylar notch area was measured. Tibial spine area, tibial spine area/body height, and tibial spine area/notch area were compared between the ACL tear and intact groups.

Results: The A-P tibial spine area of the ACL tear and intact groups was 178 ± 34 and 220.7 ± 58mm², respectively. The lateral tibial spine area of the ACL tear and intact groups was 145.7 ± 36.9 and 178.9 ± 41.7mm², respectively. The tibial spine area was significantly larger in the ACL intact group when compared with the ACL tear group (A-P: p = 0.02, lateral: p = 0.03). This trend was unchanged even when the tibial spine area was normalized by body height (A-P: p = 0.01, lateral: p = 0.02). The tibial spine area/notch area of the ACL tear and intact groups showed no significant difference.

Conclusion: The A-P and lateral tibial spine area was significantly smaller in the ACL tear group when compared with the ACL intact group. Although the sample size was limited, a small tibial spine might be a cause of knee instability, which may result in ACL injury.

Level of evidence: Level III.

Keywords: Anatomy; Anterior cruciate ligament; Tibia; Tibial spine.