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Abnormal tibial alignment is a risk factor for lateral meniscus posterior root tears in patients with anterior cruciate ligament ruptures

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to identify if abnormal tibial alignment was a risk factor for lateral meniscus posterior root tears (LMPRT) in patients with acute anterior cruciate ligament (ACL) ruptures.

Methods

The medical charts of 200 patients treated for ACL ruptures between 2013 and 2016 were retrospectively reviewed and evaluated. MRI images and reports were assessed for concurrent meniscal tears. Radiographs were reviewed for tibia vara and tibial slope angles and MRI reports identifying lateral root tears were compared to intraoperative reports to determine accuracy. Multiple logistic regression models were constructed to identify potential risk factors for LMPRTs.

Results

Of the 200 patients reviewed, a total of 97 individuals with concurrent meniscal injuries were identified. In patients sustaining a concurrent meniscal injury, there was a 4% incidence of medial meniscus posterior root tears and a 10.3% incidence of LMPRTs. Patients sustaining an ACL injury with an LMPRT were found to have greater tibia vara angles (4.2 ± 1.0 vs. 2.9 ± 1.7; p = 0.024), increased tibial slopes (12.6 ± 1.5 vs. 10.7 ± 2.9; p = 0.034), and higher BMIs (27.3 ± 2.9 vs. 25.3 ± 5.9; p = 0.034) when compared to patients without meniscus tears. There was low agreement between MRI and arthroscopic findings (kappa rate = 0.54). Multiple logistic regression analysis demonstrated that a tibia vara angle > 3 was associated with a 5.2-fold increase (95% CI 0.99–27.01; p = 0.050), and a tibial slope > 12 with a 5.4-fold increase (95% CI 1.03–28.19; p = 0.046) in LMPRTs.

Conclusions

Patients with greater tibia varus angles, increased tibial slopes, and higher BMIs were found to have an increased risk of LMPRTs when sustaining an ACL rupture. There was a low rate of agreement between MRI and arthroscopy in identifying LMPRTs. In patients with ACL ruptures who have abnormal tibial alignment or increased BMI, physicians should be watchful for lateral meniscus posterior root tears.

Level of evidence

3.

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Abbreviations

LMPRT:

Lateral meniscus posterior root tear

MMPRT:

Medial meniscus posterior root tear

ACL:

Anterior cruciate ligament

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

KLG:

Kellgren–Lawrence Grade

TPAA:

Tibial proximal anatomic axis

ATC:

Anterior tibial cortex

PTC:

Posterior tibial cortex

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Kelechi R. Okoroha, Ravi B. Patel, Omar Kadri, Toufic R. Jildeh, Eric C. Makhni & Vasilios Moutzouros

  2. Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA

    Andrew Krause & Caleb Gulledge

Authors
  1. Kelechi R. Okoroha
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  2. Ravi B. Patel
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  3. Omar Kadri
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Correspondence to Kelechi R. Okoroha.

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All authors declare that they have no conflict of interest.

Ethical approval

The local institutional review board approved this study (IRB: Henry Ford Hospital, Detroit, MI).

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Okoroha, K.R., Patel, R.B., Kadri, O. et al. Abnormal tibial alignment is a risk factor for lateral meniscus posterior root tears in patients with anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 27, 590–595 (2019). https://doi.org/10.1007/s00167-018-5171-4

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  • DOI: https://doi.org/10.1007/s00167-018-5171-4

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