»» Good afternoon. My name is Ryan Thatcher. I'm one of the PGY-5 residents at HSS. And I'll be giving our presentation today on the impact of posterior tibial slope on meniscal injury and acute ACL ruptures. I have nothing to disclose. By way of background, posterior tibial slope has previously been associated with an elevated risk of ACL rupture. Recent studies have suggested a potential relationship between posterior slope and meniscal injury in ACL ruptures. However, these studies have included chronic ACLs, revision ACLs, and had low study numbers overall. The purpose of our study was to assess the impact of posterior tibial slope on meniscal tears in a population of acute ACL ruptures. We also sought to determine other risk factors for meniscal injury in this population. This was a retrospective case series that utilized HSS's Sports Medicine Institute ACL Registry which contained demographics data as well as information on meniscal pathology. We used preoperative MRI to measure posterior tibial slope for all patients in this study. Out of a possible 4,000-plus patients that were identified in the registry, over 3,000 were ultimately excluded for the reasons that you see here, which include chronic ACLs, age outside of 18-45, contact injuries as well as revision ACLs and a few other things. So ultimately we included 1,055 patients in our study. Our analysis was broken down into three separate groups, or three separate analyses. The first grouped patients by the presence of any meniscal tear or no meniscal tear. The second grouped patients by the presence of any lateral meniscal tear or no lateral meniscal tear. And the third by the presence of any medial meniscal tear or no medial meniscal tear. Statistics for this study were as follows. Demographics and slope data were compared using students' two-tailed t-tests, categorical data with chi-squared tests. We also performed multiple logistic regression models to evaluate for risk factors for each tear outcome. This is just an example of posterior tibial slope measurement on MRI which has been validated in the literature previously. In terms of our results, this is a summary statistics table. I just wanted to draw your attention to a few things. First, in our group approximately 50% of patients had some form of meniscal tear after their acute ACL ruptures. Secondly, we saw a higher rate of lateral meniscal tears compared to medial meniscal tears at about a 3-2 ratio. And finally, medial posterior tibial slope was on average slightly greater than lateral posterior tibial slope in our population. For the results of our specific analyses in our first cohort where we broke down patients by the presence of any meniscal tear or no meniscal tear, patients that had a meniscal tear had on average a statistically significantly higher lateral posterior tibial slope than those without. These patients also had on average a higher BMI and were more likely to be male. Similarly in our lateral tear cohort, patients with any lateral meniscal tear also had greater lateral posterior tibial slopes and were on average male and had a higher BMI. It was a little bit different in our third analysis where we looked specifically at the medial tear group as patients in the medial tear group did not have on average a greater lateral posterior tibial slope or medial posterior tibial slope. They did demonstrate an association between a higher BMI and that relationship with male sex. Additionally, patients with medial tears were more likely to be older than those without. And then for the results of our simple and multivariable regression analyses, we found that increasing lateral posterior tibial slope, elevated BMI and male sex were risk factors for both any tear as well as any lateral tear in both analyses. Neither lateral posterior tibial slope nor medial posterior tibial slope was identified as a risk factor for medial tear in this cohort. So in terms of conclusions, we found that patients with any meniscal tear or any lateral meniscal tear are more likely to have increasing lateral posterior tibial slope in a large population of acute non-contact primary ACL ruptures. There was no identifiable association between medial slope and meniscal pathology in this population. Additionally, BMI and male sex were found to be consistent risk factors for meniscal injury in our group. Thank you. »» Thank you.

Dr. Ryan Thatcher

posterior tibial slope

meniscal injury

acute ACL ruptures

risk factors