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.
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Anterior cruciate ligament
Body mass index
Intra-class correlation coefficient
Lateral tibial slope
Medial meniscus posterior root tear
Magnetic resonance imaging
Medial tibial plateau depth
Medial tibial slope
Posterior root tear
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
Barber FA, Getelman MH, Berry KL (2017) Complex medial meniscus tears are associated with a biconcave medial tibial plateau. Arthroscopy 33:783–789
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
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
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
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
Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Jt Surg Br 76:745–749
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
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
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
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
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
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
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
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
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
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
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
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
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
Meyer EG, Haut RC (2005) Excessive compression of the human tibio-femoral joint causes ACL rupture. J Biomech 38:2311–2316
Moatshe G, Chahla J, Slette E, Engebretsen L, Laprade RF (2016) Posterior meniscal root injuries. Acta Orthop 87:452–458
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
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
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
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
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
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
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
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
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
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
We thank Editage (www.editage.jp) for English language editing.
No funding was received in support of this study.
Conflict of interest
The authors declare that they have no competing interests.
This study was approved by the International Review Board (IRB) of Okayama University (Ethical approval No. 1857).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Medial meniscus
- Posterior root tear
- Magnetic resonance imaging
- Medial tibial slope
- Medial tibial plateau depth