Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait.

The anterior cruciate ligament (ACL) rupture is a common knee joint injury with higher prevalence in female athletes. In search of contributing mechanisms, clinical imaging studies of ACL-injured individuals versus controls have found greater medial-lateral posterior tibial slope (PTS) in injured population irrespective of the sex and in females compared to males, with stronger evidence on the lateral plateau slope. To quantify these effects, we use a lower extremity musculoskeletal model including a detailed finite element (FE) model of the knee joint to compute the role of changes in medial and/or lateral PTS by ±5° and ±10° on knee joint biomechanics, in general, and ACL force, in particular, throughout the stance phase of gait. The model is driven by reported kinematics/kinetics of gait in asymptomatic subjects. Our predictions showed, at all stance periods, a substantial increase in the anterior tibial translation (ATT) and ACL force as PTS increased with reverse trends as PTS decreased. At mid-stance, for example, ACL force increased from 181 N to 317 N and 460 N as PTS increased by 5° and 10°, respectively, while dropped to 102 N and 0 N as PTS changed by -5° and -10°, respectively. These effects are caused primarily by change in PTS at the tibial plateau that carries a larger portion of joint contact force. Steeper PTS is a major risk factor, especially under activities with large compression, in markedly increasing ACL force and its vulnerability to injury. Rehabilitation and ACL injury prevention programs could benefit from these findings.

[1]  L. Salmon,et al.  Posterior Tibial Slope and Further Anterior Cruciate Ligament Injuries in the Anterior Cruciate Ligament–Reconstructed Patient , 2013, The American journal of sports medicine.

[2]  P. Leva Adjustments to Zatsiorsky-Seluyanov's segment inertia parameters. , 1996 .

[3]  Jin Zhang,et al.  Posterior Tibial Slope Influences Static Anterior Tibial Translation in Anterior Cruciate Ligament Reconstruction , 2014, The American journal of sports medicine.

[4]  Marcus G Pandy,et al.  Effect of posterior tibial slope on knee biomechanics during functional activity , 2011, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[5]  A Shirazi-Adl,et al.  Effect of changes in cruciate ligaments pretensions on knee joint laxity and ligament forces , 2005, Computer methods in biomechanics and biomedical engineering.

[6]  J. Hashemi,et al.  Steeper posterior tibial slope markedly increases ACL force in both active gait and passive knee joint under compression. , 2014, Journal of biomechanics.

[7]  Freddie H. Fu,et al.  Knee morphology and risk factors for developing an anterior cruciate ligament rupture: an MRI comparison between ACL-ruptured and non-injured knees , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[8]  Troy Blackburn,et al.  Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury , 2004, The American journal of sports medicine.

[9]  L. Dürselen,et al.  Increasing posterior tibial slope does not raise anterior cruciate ligament strain but decreases tibial rotation ability. , 2013, Clinical biomechanics.

[10]  L. Blankevoort,et al.  In vitro study of inter-individual variation in posterior slope in the knee joint. , 2009, Clinical biomechanics.

[11]  A. Imhoff,et al.  Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees , 2004, Archives of Orthopaedic and Trauma Surgery.

[12]  David B. Lipps,et al.  Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing , 2012, The American journal of sports medicine.

[13]  Kazuhisa Hatayama,et al.  Sagittal Alignment of the Knee and Its Relationship to Noncontact Anterior Cruciate Ligament Injuries , 2011, The American journal of sports medicine.

[14]  M. Hull,et al.  A finite element model of the human knee joint for the study of tibio-femoral contact. , 2002, Journal of biomechanical engineering.

[15]  Ayman Habib,et al.  OpenSim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement , 2007, IEEE Transactions on Biomedical Engineering.

[16]  T. Deberardino,et al.  The Relationship between Posterior Tibial Slope and Anterior Cruciate Ligament Injuries , 2010, The American journal of sports medicine.

[17]  M. Maitland,et al.  Influence of Anthropometric and Mechanical Variations on Functional Instability in the ACL-Deficient Knee , 2003, Annals of Biomedical Engineering.

[18]  Javad Hashemi,et al.  Shallow Medial Tibial Plateau and Steep Medial and Lateral Tibial Slopes: New Risk Factors for Anterior Cruciate Ligament Injuries , 2010, The American journal of sports medicine.

[19]  B. Boden,et al.  The Role of Axial Compressive and Quadriceps Forces in Noncontact Anterior Cruciate Ligament Injury , 2012, The American journal of sports medicine.

[20]  J. Agel,et al.  Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. , 2007, Journal of athletic training.

[21]  J. Slauterbeck,et al.  Geometric profile of the tibial plateau cartilage surface is associated with the risk of non‐contact anterior cruciate ligament injury , 2014, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[22]  G. Barrett,et al.  The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[23]  Freddie H. Fu,et al.  In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  T. Hewett,et al.  Anterior Cruciate Ligament Injuries in Female Athletes , 2006, The American journal of sports medicine.

[25]  K. Markolf,et al.  ACL forces and knee kinematics produced by axial tibial compression during a passive flexion–extension cycle , 2014, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[26]  A Shirazi-Adl,et al.  Biomechanics of the knee joint in flexion under various quadriceps forces. , 2005, The Knee.

[27]  Gregory D. Myer,et al.  The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes , 2008, The American journal of sports medicine.

[28]  Roger C. Haut,et al.  Tibiofemoral Contact Pressures and Osteochondral Microtrauma during Anterior Cruciate Ligament Rupture Due to Excessive Compressive Loading and Internal Torque of the Human Knee , 2008, The American journal of sports medicine.

[29]  S. Hinterwimmer,et al.  The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[30]  J. L. Astephen,et al.  Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[31]  K. Jung,et al.  ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy , 2009, Archives of Orthopaedic and Trauma Surgery.

[32]  P. Chambat,et al.  The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament. , 2011, The Journal of bone and joint surgery. British volume.

[33]  Mary T. Gabriel,et al.  Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[34]  Roger C Haut,et al.  Excessive compression of the human tibio-femoral joint causes ACL rupture. , 2005, Journal of biomechanics.

[35]  M Torode,et al.  Inter-segment foot motion and ground reaction forces over the stance phase of walking. , 2001, Clinical biomechanics.

[36]  J. Seon,et al.  Risk factors for anterior cruciate ligament injury: assessment of tibial plateau anatomic variables on conventional MRI using a new combined method , 2011, International Orthopaedics.

[37]  K. Chiu,et al.  Posterior slope of tibial plateau in Chinese. , 2000, The Journal of arthroplasty.

[38]  A. Bryant,et al.  Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries? , 2011, Knee Surgery, Sports Traumatology, Arthroscopy.

[39]  M. Stuart,et al.  Approach to the Multiply Revised ACL-Deficient Knee , 2014 .

[40]  Ryan E. Breighner,et al.  Increasing pre-activation of the quadriceps muscle protects the anterior cruciate ligament during the landing phase of a jump: an in vitro simulation. , 2010, The Knee.

[41]  T W Rudy,et al.  Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: A porcine study , 1998, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[42]  Javad Hashemi,et al.  The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. , 2008, The Journal of bone and joint surgery. American volume.

[43]  Toran D. MacLeod,et al.  Estimation of Ligament Loading and Anterior Tibial Translation in Healthy and ACL-Deficient Knees During Gait and the Influence of Increasing Tibial Slope Using EMG-Driven Approach , 2010, Annals of Biomedical Engineering.

[44]  E. Arendt,et al.  Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer , 1995, The American journal of sports medicine.

[45]  B. Boden,et al.  Tibiofemoral alignment: contributing factors to noncontact anterior cruciate ligament injury. , 2009, The Journal of bone and joint surgery. American volume.

[46]  Stephen D. Fening,et al.  The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. , 2008, The journal of knee surgery.

[47]  A. Cotten,et al.  [Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees]. , 1996, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[48]  Scott G McLean,et al.  Knee joint anatomy predicts high-risk in vivo dynamic landing knee biomechanics. , 2010, Clinical biomechanics.

[49]  B. Beynnon,et al.  Chronic anterior cruciate ligament deficiency is associated with increased anterior translation of the tibia during the transition from non‐weightbearing to weightbearing , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[50]  K. Markolf,et al.  Anterior-posterior and rotatory stability of single and double-bundle anterior cruciate ligament reconstructions. , 2009, The Journal of bone and joint surgery. American volume.

[51]  James Cho Hong Goh,et al.  Anterior Cruciate Ligament Failure and Cartilage Damage during Knee Joint Compression , 2008, The American journal of sports medicine.

[52]  M. Bonnin,et al.  Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. , 1994, The Journal of bone and joint surgery. British volume.

[53]  A. Shirazi-Adl,et al.  Consideration of equilibrium equations at the hip joint alongside those at the knee and ankle joints has mixed effects on knee joint response during gait. , 2013, Journal of biomechanics.

[54]  A. Shirazi-Adl,et al.  Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression , 2015, Computer methods in biomechanics and biomedical engineering.

[55]  M. Englund,et al.  High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. , 2004, Arthritis and rheumatism.

[56]  R J Johnson,et al.  The effect of weightbearing and external loading on anterior cruciate ligament strain. , 2001, Journal of biomechanics.

[57]  Margaret I Bullock,et al.  Factors Involved in the Development of Osteoarthritis after Anterior Cruciate Ligament Surgery , 2010, The American journal of sports medicine.

[58]  H. Nagaraja,et al.  Anterior Cruciate Ligament—Injured Subjects Have Smaller Anterior Cruciate Ligaments than Matched Controls , 2009, The American journal of sports medicine.

[59]  S. Woo,et al.  Effects of Increasing Tibial Slope on the Biomechanics of the Knee , 2004, The American journal of sports medicine.