Radiographic evaluation of posterior tibial slope in ACL deficient Indian patients


  • Ravi Kumar Department of Orthopaedics, AIIMS Patna, Bihar, India
  • Kishore Kunal Department of Orthopaedics, AIIMS Patna, Bihar, India



ACL injury, Posterior tibial slope


Background: There are several studies which have investigated various osseous morphologic characteristics as they relate to ACL injury. Tibial slope, notch width, and notch width index are some. However, there does not appear to be consensus across studies. The aim of this study was to validate association between posterior tibial slope (PTS) and ACL injury in an ACL deficient knee of Indian patients.

Methods: This retrospective cum prospective study was done at a tertiary hospital from June 2017 to May 2018. 40 patients were included. Inclusion criteria were documented evidence of ACL tear to the affected knee; no history of osteoarthritis; no history of rheumatoid arthritis; patients voluntarily consented for the use of their radiographs for the study. The assessment was completed with a true lateral view of the knee with full length leg and ankle. The functional tibial slope as described by Julliard et al was used to determine the PTS. The mean and standard deviation (SD) for medial PTS were measured. Demographic data like age, sex were collected and entered into a database.

Results: 95% of patients were male. Mean age was 29.25. The mean PTS was 13.037 which is reasonably high as compared to normal while the standard deviation was 4.487 reflecting large amount of variation.

Conclusions: Increased posterior tibial slope can be concluded as a significant risk factor in ACL injury which corroborates the findings of various previously published studies. The findings presented may help identify patients who are at greater risk of ACL injury. 

Author Biographies

Ravi Kumar, Department of Orthopaedics, AIIMS Patna, Bihar, India

Department of Orthopaedics , AIIMS Patna

Kishore Kunal, Department of Orthopaedics, AIIMS Patna, Bihar, India

Department of Orthopaedics , AIIMS Patna


Andernord D, Desai N, Bjo¨ rnsson H, Ylander M, Karlsson J, Samuelsson K. Patient predictors of early revision surgery after anterior cruciate ligament reconstruction:a cohort study of 16,930 patients with 2-year follow-up. Am J Sports Med. 2015;43(1):121-7.

Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta – analysis of the state of play. Br J Sports Med. 2011;45(7):596-606.

Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech. 2010;43(9):1702-7.

Todd MS, Lalliss S, Garcia E, DeBerardino TM, Cameron KL. The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 2010;38 (1):63-7.

Frick H, Leonhardt H, Starck D. Allgemeine Anatomie, Spezielle Anatomie I. Stuttgart, Germany Thieme Publishing House, 1992.

Brazier J, Migaud H, Gougon F, Cotten A, Fontaine C, Duquennoy A. Evaluation of methods for radiographic measurements of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot. 1996;82(3):195-200.

Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF. The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy. 2006;22(8):894-9.

Sonnery-Cottet B, Archbold P, Cucurulo T, Fayard JM, Bortolletto J, Thaunat M, et al. The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament. J Bone Joint Surg Br. 2011;93(11):1475-8.

Zeng C, Yang T, Wu S, Gao SG, Li H, Deng ZH, et al. Is posterior tibial slope associated with noncontact anterior cruciate ligament injury? Knee Surg Sports Traumatol Arthrosc. 2016;24(3):830-7.

Meister K, Talley MC, Horodyski MB, Indelicato PA, Hartzel JS, Batts J. Caudal slope of the tibia and its relationship to noncontact injuries to the ACL. Am J Knee Surg. 1998;11(4):217-9.

Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture:two radiological tests compared. J Bone Joint Surg Br. 1994;76(5):745-9.

Fukubayashi T, Torzilli PA, Sherman MF, Warren RF. An in vitro biomechanical evaluation of anterior – posterior motion of the knee:tibial displacement, rotation, and torque. J Bone Joint Surg Am. 1982;64(2):258-64.

Shao Q, MacLeod TD, Manal K, Buchanan TS. 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. Ann Biomed Eng. 2011;39(1):110-21.

Shelburne KB, Kim H-J, Sterett WI, Pandy MG. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res. 2011;29(2):223-31.

Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament –reconstructed patient. Am J Sports Med. 2013;41(12):2800-4.

Julliard R, Genin P, Weil G, Palmkrantz P. The median functional slope of the tibia. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(8):625-34.

Mukherjee A, Sharma A, Garg V, Maini L, Bajaj P. Role of Posterior Tibial Slope in ACL Deficient in Indian Population. J Arthroscopy Joint Surg. 2017;4(2):83-8.

Muthuuri JM. Determination of posterior tibia slope and slope deterioration with osteoarthritis: a radiological study in an African population. East African Orthop J. 2014;8:16-20

Chiur KY, Zhang GH. Posterior slope of tibial plateau in Chinese. J Arthroplasty. 2000;15(2):224-7.

Şenışık S, Özgürbüz C, Ergün M, Yüksel O, Taşkıran E, İşlegen C, et al. Posterior Tibial Slope as a Risk Factor for Anterior Cruciate Ligament Rupture in Soccer Players. J Sports Sci Med. 2011;10:763-7.

Bisson LJ, Gurske-DePerio J. Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: a case control study. Arthroscopy. 2010;26:901-6.

Hashemi J1, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr, et al. Shallow medial tibial plateau and steep medial and lateral tibial slopes:new risk factors for anterior cruciate ligament injuries. Am J Sports Med. 2010;38:54-62.

Stijak L, Herzog RF, Schai P. Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc. 2008;16:112-7.

Waiwaiole A, Gurbani A, Motamedi K, Seeger L, Sim MS, Nwajuaku P, et al. Relationship of ACL Injury and Posterior Tibial Slope With Patient Age, Sex, and Race. Orthop J Sports Med. 2016;4(11):2325967116672852.

Noyes FR, Barber Westin SD. Anterior cruciate ligament injury prevention training in female athletes:a systematic review of injury reduction and results of athletic performance tests. Sports Health. 2012;4(1):36-46.

Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769-76.

Swart E, Redler L, Fabricant PD, Mandelbaum BR, Ahmad CS, Wang YC. Prevention and screening programs for anterior cruciate ligament injuries in young athletes:a cost- effectiveness analysis. J Bone Joint Surg Am. 2014;96 (9):705-11.






Original Research Articles