Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction
Background: Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have...
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| Veröffentlicht in: | The American journal of sports medicine 2023-04, Vol.51 (5), p.1194-1201 |
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| creator | Yoon, Kyoung Ho Lee, Jong-Hwan Kim, Sang-Gyun Park, Jae-Young Lee, Hee-Sung Kim, Sang Jin Kim, Yoon-Seok |
| description | Background:
Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have shown that a flattened PTS is associated with a lesser reduction in posterior tibial translation. There is no long-term study on the clinical outcomes and graft survival rates of SB PCL reconstruction based on the medial and lateral PTSs measured on magnetic resonance imaging.
Hypothesis:
Flattened medial and lateral PTSs are associated with poor clinical outcomes and graft survival rates at a minimum 10-year follow-up after SB PCL reconstruction.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this cohort study, we retrospectively reviewed 46 patients (mean age, 28.8 ± 9.9 years) who underwent primary SB PCL reconstruction between 2000 and 2009. They were followed up for a minimum of 10 years. The medial and lateral PTSs were measured on preoperative magnetic resonance imaging. As a previous study reported that a steeper medial or lateral PTS showed a higher risk of anterior tibial translation at thresholds of 5.6° and 3.8°, respectively, the patients were divided into 2 groups based on the cutoff values of both the medial (≤5.6° vs >5.6°) and lateral (≤3.8° vs >3.8°) PTSs. Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score), radiological outcomes (side-to-side difference [SSD] on stress radiography and osteoarthritis progression), and graft survival rates were compared between the groups at the last follow-up.
Results:
All clinical scores and the progression of osteoarthritis demonstrated no significant difference between the 2 subgroups of both the medial and lateral PTS groups. The mean SSD on stress radiography after SB PCL reconstruction was significantly greater in patients with a medial PTS ≤5.6° than in patients with a medial PTS >5.6° (8.4 ± 3.9 vs 5.1 ± 2.9 mm, respectively; P = .030), while the lateral PTS subgroups after SB PCL reconstruction demonstrated no significant difference. The minimum 10-year graft survival rate was significantly lower in patients with a medial PTS ≤5.6° (68.4% vs 92.6%, respectively; P = .029) and a lateral PTS ≤3.8° (50.0% vs 91.7%, respectively; P = .001).
Conclusion:
A flattened medial PTS (≤5.6°) was associated with an increased SSD on st |
| doi_str_mv | 10.1177/03635465231156621 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2793985545</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_03635465231156621</sage_id><sourcerecordid>2793657174</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-eefa397018c27562007832cdd64b8d935569ad1fe0b81b82ff57e9a576ac88623</originalsourceid><addsrcrecordid>eNp1kU1vEzEQhi0EoqHwA7ggS1y4bPHY8cceS1QKUiSqphw4rbzeceRqsw62t1L_Az8ah5QPgTiNNPO874zmJeQlsDMArd8yoYRcKskFgFSKwyOyACl5I4SSj8niMG8OwAl5lvMtYwy0Mk_JiVAt1wDtgny78B5dodHTq5gLphATvQl9sCPdjHGPmcaJXibrC93M6S7c1cG1LbVvCwVGv6BNmZ77KqVXKexsuqebMG1HbN7N0zDiH76rNLtQtXQdtnaHU6HX6OKUS-2XEKfn5Im3Y8YXD_WUfH5_cbP60Kw_XX5cna8bJ5QpDaK3otUMjONaKs6YNoK7YVDL3gytkFK1dgCPrDfQG-691NhaqZV1xiguTsmbo-8-xa8z5tLtQnY4jnbCOOeO61a0RsqlrOjrv9DbOKepXveDUlKDXlYKjpRLMeeEvtsfX9EB6w5Rdf9EVTWvHpznfofDL8XPbCpwdgSy3eLvtf93_A668Zt2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2793657174</pqid></control><display><type>article</type><title>Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Yoon, Kyoung Ho ; Lee, Jong-Hwan ; Kim, Sang-Gyun ; Park, Jae-Young ; Lee, Hee-Sung ; Kim, Sang Jin ; Kim, Yoon-Seok</creator><creatorcontrib>Yoon, Kyoung Ho ; Lee, Jong-Hwan ; Kim, Sang-Gyun ; Park, Jae-Young ; Lee, Hee-Sung ; Kim, Sang Jin ; Kim, Yoon-Seok</creatorcontrib><description>Background:
Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have shown that a flattened PTS is associated with a lesser reduction in posterior tibial translation. There is no long-term study on the clinical outcomes and graft survival rates of SB PCL reconstruction based on the medial and lateral PTSs measured on magnetic resonance imaging.
Hypothesis:
Flattened medial and lateral PTSs are associated with poor clinical outcomes and graft survival rates at a minimum 10-year follow-up after SB PCL reconstruction.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this cohort study, we retrospectively reviewed 46 patients (mean age, 28.8 ± 9.9 years) who underwent primary SB PCL reconstruction between 2000 and 2009. They were followed up for a minimum of 10 years. The medial and lateral PTSs were measured on preoperative magnetic resonance imaging. As a previous study reported that a steeper medial or lateral PTS showed a higher risk of anterior tibial translation at thresholds of 5.6° and 3.8°, respectively, the patients were divided into 2 groups based on the cutoff values of both the medial (≤5.6° vs >5.6°) and lateral (≤3.8° vs >3.8°) PTSs. Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score), radiological outcomes (side-to-side difference [SSD] on stress radiography and osteoarthritis progression), and graft survival rates were compared between the groups at the last follow-up.
Results:
All clinical scores and the progression of osteoarthritis demonstrated no significant difference between the 2 subgroups of both the medial and lateral PTS groups. The mean SSD on stress radiography after SB PCL reconstruction was significantly greater in patients with a medial PTS ≤5.6° than in patients with a medial PTS >5.6° (8.4 ± 3.9 vs 5.1 ± 2.9 mm, respectively; P = .030), while the lateral PTS subgroups after SB PCL reconstruction demonstrated no significant difference. The minimum 10-year graft survival rate was significantly lower in patients with a medial PTS ≤5.6° (68.4% vs 92.6%, respectively; P = .029) and a lateral PTS ≤3.8° (50.0% vs 91.7%, respectively; P = .001).
Conclusion:
A flattened medial PTS (≤5.6°) was associated with an increased SSD on stress radiography, and both flattened medial (≤5.6°) and lateral (≤3.8°) PTSs resulted in lower graft survival rates at a minimum 10-year follow-up after primary SB PCL reconstruction.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/03635465231156621</identifier><identifier>PMID: 36927119</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Anterior Cruciate Ligament Injuries - surgery ; Arthritis ; Clinical outcomes ; Cohort analysis ; Cohort Studies ; Graft Survival ; Humans ; Knee ; Knee Joint - surgery ; Magnetic resonance imaging ; Osteoarthritis ; Osteoarthritis - surgery ; Posterior Cruciate Ligament - diagnostic imaging ; Posterior Cruciate Ligament - surgery ; Posterior Cruciate Ligament Reconstruction - methods ; Radiography ; Retrospective Studies ; Sports medicine ; Tibia - diagnostic imaging ; Tibia - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>The American journal of sports medicine, 2023-04, Vol.51 (5), p.1194-1201</ispartof><rights>2023 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-eefa397018c27562007832cdd64b8d935569ad1fe0b81b82ff57e9a576ac88623</citedby><cites>FETCH-LOGICAL-c368t-eefa397018c27562007832cdd64b8d935569ad1fe0b81b82ff57e9a576ac88623</cites><orcidid>0000-0001-7635-9157</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/03635465231156621$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/03635465231156621$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36927119$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoon, Kyoung Ho</creatorcontrib><creatorcontrib>Lee, Jong-Hwan</creatorcontrib><creatorcontrib>Kim, Sang-Gyun</creatorcontrib><creatorcontrib>Park, Jae-Young</creatorcontrib><creatorcontrib>Lee, Hee-Sung</creatorcontrib><creatorcontrib>Kim, Sang Jin</creatorcontrib><creatorcontrib>Kim, Yoon-Seok</creatorcontrib><title>Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have shown that a flattened PTS is associated with a lesser reduction in posterior tibial translation. There is no long-term study on the clinical outcomes and graft survival rates of SB PCL reconstruction based on the medial and lateral PTSs measured on magnetic resonance imaging.
Hypothesis:
Flattened medial and lateral PTSs are associated with poor clinical outcomes and graft survival rates at a minimum 10-year follow-up after SB PCL reconstruction.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this cohort study, we retrospectively reviewed 46 patients (mean age, 28.8 ± 9.9 years) who underwent primary SB PCL reconstruction between 2000 and 2009. They were followed up for a minimum of 10 years. The medial and lateral PTSs were measured on preoperative magnetic resonance imaging. As a previous study reported that a steeper medial or lateral PTS showed a higher risk of anterior tibial translation at thresholds of 5.6° and 3.8°, respectively, the patients were divided into 2 groups based on the cutoff values of both the medial (≤5.6° vs >5.6°) and lateral (≤3.8° vs >3.8°) PTSs. Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score), radiological outcomes (side-to-side difference [SSD] on stress radiography and osteoarthritis progression), and graft survival rates were compared between the groups at the last follow-up.
Results:
All clinical scores and the progression of osteoarthritis demonstrated no significant difference between the 2 subgroups of both the medial and lateral PTS groups. The mean SSD on stress radiography after SB PCL reconstruction was significantly greater in patients with a medial PTS ≤5.6° than in patients with a medial PTS >5.6° (8.4 ± 3.9 vs 5.1 ± 2.9 mm, respectively; P = .030), while the lateral PTS subgroups after SB PCL reconstruction demonstrated no significant difference. The minimum 10-year graft survival rate was significantly lower in patients with a medial PTS ≤5.6° (68.4% vs 92.6%, respectively; P = .029) and a lateral PTS ≤3.8° (50.0% vs 91.7%, respectively; P = .001).
Conclusion:
A flattened medial PTS (≤5.6°) was associated with an increased SSD on stress radiography, and both flattened medial (≤5.6°) and lateral (≤3.8°) PTSs resulted in lower graft survival rates at a minimum 10-year follow-up after primary SB PCL reconstruction.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Arthritis</subject><subject>Clinical outcomes</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Magnetic resonance imaging</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis - surgery</subject><subject>Posterior Cruciate Ligament - diagnostic imaging</subject><subject>Posterior Cruciate Ligament - surgery</subject><subject>Posterior Cruciate Ligament Reconstruction - methods</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Sports medicine</subject><subject>Tibia - diagnostic imaging</subject><subject>Tibia - surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1vEzEQhi0EoqHwA7ggS1y4bPHY8cceS1QKUiSqphw4rbzeceRqsw62t1L_Az8ah5QPgTiNNPO874zmJeQlsDMArd8yoYRcKskFgFSKwyOyACl5I4SSj8niMG8OwAl5lvMtYwy0Mk_JiVAt1wDtgny78B5dodHTq5gLphATvQl9sCPdjHGPmcaJXibrC93M6S7c1cG1LbVvCwVGv6BNmZ77KqVXKexsuqebMG1HbN7N0zDiH76rNLtQtXQdtnaHU6HX6OKUS-2XEKfn5Im3Y8YXD_WUfH5_cbP60Kw_XX5cna8bJ5QpDaK3otUMjONaKs6YNoK7YVDL3gytkFK1dgCPrDfQG-691NhaqZV1xiguTsmbo-8-xa8z5tLtQnY4jnbCOOeO61a0RsqlrOjrv9DbOKepXveDUlKDXlYKjpRLMeeEvtsfX9EB6w5Rdf9EVTWvHpznfofDL8XPbCpwdgSy3eLvtf93_A668Zt2</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Yoon, Kyoung Ho</creator><creator>Lee, Jong-Hwan</creator><creator>Kim, Sang-Gyun</creator><creator>Park, Jae-Young</creator><creator>Lee, Hee-Sung</creator><creator>Kim, Sang Jin</creator><creator>Kim, Yoon-Seok</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7635-9157</orcidid></search><sort><creationdate>202304</creationdate><title>Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction</title><author>Yoon, Kyoung Ho ; Lee, Jong-Hwan ; Kim, Sang-Gyun ; Park, Jae-Young ; Lee, Hee-Sung ; Kim, Sang Jin ; Kim, Yoon-Seok</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-eefa397018c27562007832cdd64b8d935569ad1fe0b81b82ff57e9a576ac88623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Arthritis</topic><topic>Clinical outcomes</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Magnetic resonance imaging</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis - surgery</topic><topic>Posterior Cruciate Ligament - diagnostic imaging</topic><topic>Posterior Cruciate Ligament - surgery</topic><topic>Posterior Cruciate Ligament Reconstruction - methods</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Sports medicine</topic><topic>Tibia - diagnostic imaging</topic><topic>Tibia - surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoon, Kyoung Ho</creatorcontrib><creatorcontrib>Lee, Jong-Hwan</creatorcontrib><creatorcontrib>Kim, Sang-Gyun</creatorcontrib><creatorcontrib>Park, Jae-Young</creatorcontrib><creatorcontrib>Lee, Hee-Sung</creatorcontrib><creatorcontrib>Kim, Sang Jin</creatorcontrib><creatorcontrib>Kim, Yoon-Seok</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoon, Kyoung Ho</au><au>Lee, Jong-Hwan</au><au>Kim, Sang-Gyun</au><au>Park, Jae-Young</au><au>Lee, Hee-Sung</au><au>Kim, Sang Jin</au><au>Kim, Yoon-Seok</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2023-04</date><risdate>2023</risdate><volume>51</volume><issue>5</issue><spage>1194</spage><epage>1201</epage><pages>1194-1201</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have shown that a flattened PTS is associated with a lesser reduction in posterior tibial translation. There is no long-term study on the clinical outcomes and graft survival rates of SB PCL reconstruction based on the medial and lateral PTSs measured on magnetic resonance imaging.
Hypothesis:
Flattened medial and lateral PTSs are associated with poor clinical outcomes and graft survival rates at a minimum 10-year follow-up after SB PCL reconstruction.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this cohort study, we retrospectively reviewed 46 patients (mean age, 28.8 ± 9.9 years) who underwent primary SB PCL reconstruction between 2000 and 2009. They were followed up for a minimum of 10 years. The medial and lateral PTSs were measured on preoperative magnetic resonance imaging. As a previous study reported that a steeper medial or lateral PTS showed a higher risk of anterior tibial translation at thresholds of 5.6° and 3.8°, respectively, the patients were divided into 2 groups based on the cutoff values of both the medial (≤5.6° vs >5.6°) and lateral (≤3.8° vs >3.8°) PTSs. Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score), radiological outcomes (side-to-side difference [SSD] on stress radiography and osteoarthritis progression), and graft survival rates were compared between the groups at the last follow-up.
Results:
All clinical scores and the progression of osteoarthritis demonstrated no significant difference between the 2 subgroups of both the medial and lateral PTS groups. The mean SSD on stress radiography after SB PCL reconstruction was significantly greater in patients with a medial PTS ≤5.6° than in patients with a medial PTS >5.6° (8.4 ± 3.9 vs 5.1 ± 2.9 mm, respectively; P = .030), while the lateral PTS subgroups after SB PCL reconstruction demonstrated no significant difference. The minimum 10-year graft survival rate was significantly lower in patients with a medial PTS ≤5.6° (68.4% vs 92.6%, respectively; P = .029) and a lateral PTS ≤3.8° (50.0% vs 91.7%, respectively; P = .001).
Conclusion:
A flattened medial PTS (≤5.6°) was associated with an increased SSD on stress radiography, and both flattened medial (≤5.6°) and lateral (≤3.8°) PTSs resulted in lower graft survival rates at a minimum 10-year follow-up after primary SB PCL reconstruction.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>36927119</pmid><doi>10.1177/03635465231156621</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7635-9157</orcidid></addata></record> |
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| ispartof | The American journal of sports medicine, 2023-04, Vol.51 (5), p.1194-1201 |
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| language | eng |
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| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Adult Anterior Cruciate Ligament Injuries - surgery Arthritis Clinical outcomes Cohort analysis Cohort Studies Graft Survival Humans Knee Knee Joint - surgery Magnetic resonance imaging Osteoarthritis Osteoarthritis - surgery Posterior Cruciate Ligament - diagnostic imaging Posterior Cruciate Ligament - surgery Posterior Cruciate Ligament Reconstruction - methods Radiography Retrospective Studies Sports medicine Tibia - diagnostic imaging Tibia - surgery Treatment Outcome Young Adult |
| title | Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction |
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