title: The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee.
abstract: BACKGROUND
  Proximal tibial slope has been shown to influence anteroposterior translation and tibial resting point in the posterior cruciate ligament (PCL)-deficient knee. The effect of proximal tibial slope on rotational stability of the knee is unknown.
  
  
  OBJECTIVE
  Change in proximal tibial slope produced via osteotomy can influence both static translation and dynamic rotational kinematics in the PCL/posterolateral corner (PLC)-deficient knee.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Posterior drawer, dial, and mechanized reverse pivot-shift (RPS) tests were performed on hip-to-toe specimens and translation of the lateral and medial compartments measured utilizing navigation (n = 10). The PCL and structures of the PLC were then sectioned. Stability testing was repeated, and compartmental translation was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5° or -5° of tibial slope variation, after which stability testing was repeated (n = 10). Analysis was performed using 1-way analysis of variance (ANOVA; α = .05).
  
  
  RESULTS
  Combined sectioning of the PCL and PLC structures resulted in a 10.5-mm increase in the posterior drawer, 15.5-mm increase in the dial test at 30°, 14.5-mm increase in the dial test at 90°, and 17.9-mm increase in the RPS (vs intact; P < .05). Increasing the posterior slope (high tibial osteotomy [HTO] +5°) in the PCL/PLC-deficient knee reduced medial compartment translation by 3.3 mm during posterior drawer (vs deficient; P < .05) but had no significant effect on the dial test at 30°, dial test at 90°, or RPS. Conversely, reversing the slope (HTO -5°) caused a 4.8-mm increase in medial compartment translation (vs deficient state; P < .05) during posterior drawer and an 8.6-mm increase in lateral compartment translation and 9.0-mm increase in medial compartment translation during RPS (vs deficient state; P < .05).
  
  
  CONCLUSIONS
  Increasing posterior tibial slope diminished static posterior instability of the PCL/PLC-deficient knee as measured by the posterior drawer test but had little effect on rotational or dynamic multiplanar stability as assessed by the dial and RPS tests, respectively. Conversely, decreasing posterior slope resulted in increased posterior instability and a significant increase in the magnitude of the RPS.
  
  
  CONCLUSIONS
  These results suggest that increasing posterior tibial slope may improve sagittal stability in the PCL/PLC-deficient knee. Moreover, a knee with diminished posterior tibial slope may demonstrate greater multiplanar instability in this setting. Consequently, proximal tibial slope should be considered when treating combined PCL/PLC injuries of the knee.
authors.affiliation: Computer Assisted Surgery Laboratory, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA. fpetrigliano@mednet.ucla.edu
authors.forename: Frank A
authors.initials: FA
authors.lastname: Petrigliano
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Suero
authors.forename: James E
authors.initials: JE
authors.lastname: Voos
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pearle
authors.forename: Answorth A
authors.initials: AA
authors.lastname: Allen
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery; D007717:Knee / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D016119:Posterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery; D013977:Tibia / Q000503:physiopathology* / Q000601:surgery