The Knee · 2025
Are joint line convergence angle and tibial slope related to bucket handle medial meniscal tear in chronic anterior cruciate ligament insufficiency?
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Arzu Ufuk, Darılmaz Muhammed Furkan, Ekinci Mehmet, Kızılkurt Taha, Erdil Mehmet Emin, Polat Gökhan
Аннотация
BACKGROUND: This study aimed to assess the relationship between the joint line convergence angle (JLCA), posterior tibial slope (PTS), and anatomic medial proximal tibial angle (aMPTA) with bucket handle medial meniscus tears in patients with chronic anterior cruciate ligament (ACL) deficiency. It was hypothesized that increased joint obliquity and PTS might elevate the risk of such tears in chronic ACL insufficiency.
METHODS: A total of 120 patients, who underwent primary ACL reconstruction surgery between 2012 and 2023 due to chronic ACL deficiency (ACL injury > 3 months) were retrospectively analyzed, except for those patients with isolated medial meniscal tear, isolated acute ACL injuries on primary MRI (without medial meniscus injury), combined ligamentous injuries (except for Grades 1-2 medial collateral ligament injuries), Grade 2-4 chondral injuries and lateral meniscal tears prior to the surgery on the same or opposite lower extremity. Their anatomic lateral distal femoral angle (aLDFA), aMPTA, JLCA, and PTS were measured using plain radiography and magnetic resonance imaging.
RESULTS: Of the 120 patients, 75 (62.5 %) had bucket handle tears (Group 1), while 45 (37.5 %) did not (Group 2). Group 1 showed significantly higher JLCA, PTS, and aMPTA values than Group 2 (p = 0.004, p < 0.001, p < 0.001). No significant difference was observed in aLDFA (p = 0.131). Chronic ACL-deficient knees with joint obliquity had a 1.62 times greater risk of developing bucket handle tears.
CONCLUSION: JLCA, PTS, and MPTA are statistically significant predictors of bucket handle tear in the medial meniscus in knees with chronic ACL deficit.
LEVEL OF EVIDENCE: 3, retrospective cohort study.
METHODS: A total of 120 patients, who underwent primary ACL reconstruction surgery between 2012 and 2023 due to chronic ACL deficiency (ACL injury > 3 months) were retrospectively analyzed, except for those patients with isolated medial meniscal tear, isolated acute ACL injuries on primary MRI (without medial meniscus injury), combined ligamentous injuries (except for Grades 1-2 medial collateral ligament injuries), Grade 2-4 chondral injuries and lateral meniscal tears prior to the surgery on the same or opposite lower extremity. Their anatomic lateral distal femoral angle (aLDFA), aMPTA, JLCA, and PTS were measured using plain radiography and magnetic resonance imaging.
RESULTS: Of the 120 patients, 75 (62.5 %) had bucket handle tears (Group 1), while 45 (37.5 %) did not (Group 2). Group 1 showed significantly higher JLCA, PTS, and aMPTA values than Group 2 (p = 0.004, p < 0.001, p < 0.001). No significant difference was observed in aLDFA (p = 0.131). Chronic ACL-deficient knees with joint obliquity had a 1.62 times greater risk of developing bucket handle tears.
CONCLUSION: JLCA, PTS, and MPTA are statistically significant predictors of bucket handle tear in the medial meniscus in knees with chronic ACL deficit.
LEVEL OF EVIDENCE: 3, retrospective cohort study.