Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears

Knee Surgery, Sports Traumatology, Arthroscopy volume 29, pages44–50(2021)Cite this article

Abstract

Purpose

Bone morphological factors are important for menisci. Their association with medial meniscus posterior root tears, however, has not yet been studied. This study aimed to compare sagittal medial tibial slope and medial tibial plateau depth between knees with and without medial meniscus posterior root tears.

Methods

Nine healthy volunteers, 24 patients who underwent anterior cruciate ligament reconstruction, and 36 patients who underwent medial meniscus posterior root pullout repair were included. Magnetic resonance imaging examinations were performed in the 10°-knee-flexed position. The medial tibial slope and medial tibial plateau depth were compared among the groups.

Results

In healthy volunteers, the anterior cruciate ligament reconstruction group, and the medial meniscus posterior root tear group, the medial tibial slopes were 3.5° ± 1.4°, 4.0° ± 1.9°, and 7.2° ± 1.9°, respectively, and the medial tibial plateau depths were 2.1 ± 0.7 mm, 2.2 ± 0.6 mm, and 1.2 ± 0.5 mm, respectively. Patients with medial meniscus posterior root tears had a significantly steep medial tibial slope and shallow medial tibial plateau concavity compared to those of healthy volunteers (P < 0.01) and the anterior cruciate ligament group (P < 0.01). In the multivariate logistic regression analysis, body mass index, medial tibial slope, and medial tibial plateau depth were significantly associated with medial meniscus posterior root tears.

Conclusions

A steep posterior slope and a shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tear.

Level of evidence

Level III: Case–control study.

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Abbreviations

ACL:

Anterior cruciate ligament

BMI:

Body mass index

ICC:

Intra-class correlation coefficient

LTS:

Lateral tibial slope

MMPRT:

Medial meniscus posterior root tear

MRI:

Magnetic resonance imaging

MTPD:

Medial tibial plateau depth

MTS:

Medial tibial slope

PRT:

Posterior root tear

References

  1. 1.

    Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584

    CAS  Article  Google Scholar 

  2. 2.

    Barber FA, Getelman MH, Berry KL (2017) Complex medial meniscus tears are associated with a biconcave medial tibial plateau. Arthroscopy 33:783–789

    Article  Google Scholar 

  3. 3.

    Beynnon B, Yu J, Huston D, Fleming B, Johnson R, Haugh L et al (1996) A sagittal plane model of the knee and cruciate ligaments with application of a sensitivity analysis. J Biomech Eng 118:227–239

    CAS  Article  Google Scholar 

  4. 4.

    Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24:1455–1468

    Article  Google Scholar 

  5. 5.

    Chung KS, Ha JK, Ra HJ, Kim JG (2016) Prognostic factors in the midterm results of pullout fixation for posterior root tears of the medial meniscus. Arthroscopy 32:1319–1327

    Article  Google Scholar 

  6. 6.

    Cinotti G, Sessa P, Ragusa G, Ripani FR, Postacchini R, Masciangelo R et al (2013) Influence of cartilage and menisci on the sagittal slope of the tibial plateaus. Clin Anat 26:883–892

    PubMed  Google Scholar 

  7. 7.

    Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Jt Surg Br 76:745–749

    CAS  Article  Google Scholar 

  8. 8.

    Feucht MJ, Salzmann GM, Bode G, Pestka JM, Kuhle J, Sudkamp NP et al (2015) Posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23:119–125

    Article  Google Scholar 

  9. 9.

    Furumatsu T, Okazaki Y, Okazaki Y, Hino T, Kamatsuki Y, Masuda S et al (2019) Injury patterns of medial meniscus posterior root tears. Orthop Traumatol Surg Res 105:107–111

    Article  Google Scholar 

  10. 10.

    Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382

    Article  Google Scholar 

  11. 11.

    Hashemi J, Chandrashekar N, Gill B, Beynnon BD, Slauterbeck JR, Schutt RC Jr et al (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Jt Surg Am 90:2724–2734

    Article  Google Scholar 

  12. 12.

    Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr et al (2010) Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 38:54–62

    Article  Google Scholar 

  13. 13.

    Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467:2066–2072

    Article  Google Scholar 

  14. 14.

    Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ et al (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610

    Article  Google Scholar 

  15. 15.

    Khan N, McMahon P, Obaid H (2014) Bony morphology of the knee and non-traumatic meniscal tears: is there a role for meniscal impingement? Skeletal Radiol 43:955–962

    Article  Google Scholar 

  16. 16.

    Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354

    Article  Google Scholar 

  17. 17.

    Kolbe R, Schmidt-Hebbel A, Forkel P, Pogorzelski J, Imhoff AB, Feucht MJ (2018) Steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant posterolateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5279-6

    Article  PubMed  Google Scholar 

  18. 18.

    Lipps DB, Wilson AM, Ashton-Miller JA, Wojtys EM (2012) Evaluation of different methods for measuring lateral tibial slope using magnetic resonance imaging. Am J Sports Med 40:2731–2736

    Article  Google Scholar 

  19. 19.

    Luczkiewicz P, Daszkiewicz K, Witkowski W, Chroscielewski J, Zarzycki W (2015) Influence of meniscus shape in the cross sectional plane on the knee contact mechanics. J Biomech 48:1356–1363

    Article  Google Scholar 

  20. 20.

    Marouane H, Shirazi-Adl A, Hashemi J (2015) Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait. J Biomech 48:1899–1905

    CAS  Article  Google Scholar 

  21. 21.

    Meyer EG, Haut RC (2005) Excessive compression of the human tibio-femoral joint causes ACL rupture. J Biomech 38:2311–2316

    Article  Google Scholar 

  22. 22.

    Moatshe G, Chahla J, Slette E, Engebretsen L, Laprade RF (2016) Posterior meniscal root injuries. Acta Orthop 87:452–458

    Article  Google Scholar 

  23. 23.

    Nagai K, Tashiro Y, Herbst E, Gale T, Wang JH, Irrgang JJ et al (2018) Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:3717–3723

    Article  Google Scholar 

  24. 24.

    Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Masuda S, Ozaki T (2019) Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stiches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709

    Article  Google Scholar 

  25. 25.

    Shelburne KB, Kim HJ, Sterett WI, Pandy MG (2011) Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 29:223–231

    Article  Google Scholar 

  26. 26.

    Song GY, Liu X, Zhang H, Wang QQ, Zhang J, Li Y et al (2016) Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med 44:2039–2046

    Article  Google Scholar 

  27. 27.

    Song GY, Zhang H, Zhang J, Liu X, Xue Z, Qian Y et al (2018) Greater static anterior tibial subluxation of the lateral compartment after an acute anterior cruciate ligament injury is associated with an increased posterior tibial slope. Am J Sports Med 46:1617–1623

    Article  Google Scholar 

  28. 28.

    Takahashi K, Hashimoto S, Kiuchi S, Watanabe A, Nakamura H, Ikuta F et al (2018) Bone morphological factors influencing cartilage degeneration in the knee. Mod Rheumatol 28:351–357

    Article  Google Scholar 

  29. 29.

    Weinberg DS, Williamson DF, Gebhart JJ, Knapik DM, Voos JE (2017) Differences in medial and lateral posterior tibial slope: an osteological review of 1090 Tibiae comparing age, sex, and race. Am J Sports Med 45:106–113

    Article  Google Scholar 

  30. 30.

    Wu J, Huang JM, Zhao B, Cao JG, Chen X (2016) Risk factors comparison for radial and horizontal tears. J Knee Surg 29:679–683

    Article  Google Scholar 

  31. 31.

    Yamagami R, Taketomi S, Inui H, Tahara K, Tanaka S (2017) The role of medial meniscus posterior root tear and proximal tibial morphology in the development of spontaneous osteonecrosis and osteoarthritis of the knee. Knee 24:390–395

    Article  Google Scholar 

  32. 32.

    Zhang Y, Chen Y, Qiang M, Zhang K, Li H, Jiang Y et al (2018) Comparison between three-dimensional CT and conventional radiography in proximal tibia morphology. Medicine (Baltimore) 97:e11632

    Article  Google Scholar 

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Acknowledgements

We thank Editage (www.editage.jp) for English language editing.

Funding

No funding was received in support of this study.

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Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan

    Yuki Okazaki, Takayuki Furumatsu, Yuya Kodama, Yusuke Kamatsuki, Yoshiki Okazaki, Takaaki Hiranaka, Shota Takihira, Tomonori Tetsunaga, Kenta Saiga & Toshifumi Ozaki

Authors
  1. Yuki Okazaki
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  2. Takayuki Furumatsu
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Contributions

TF designed the study. YuKo, YuKa, and YuO contributed to the analysis and interpretation of data. All authors have contributed to data collection and interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Takayuki Furumatsu.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the International Review Board (IRB) of Okayama University (Ethical approval No. 1857).

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Okazaki, Y., Furumatsu, T., Kodama, Y. et al. Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 29, 44–50 (2021). https://doi.org/10.1007/s00167-019-05590-4

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Keywords

  • Medial meniscus
  • Posterior root tear
  • Magnetic resonance imaging
  • Medial tibial slope
  • Medial tibial plateau depth