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Farid AR, Pradhan P, Stearns SA, Kocher MS, Fabricant PD. Association Between Posterior Tibial Slope and ACL Injury in Pediatric Patients: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:2911-2918. [PMID: 38275009 DOI: 10.1177/03635465231199649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients. PURPOSE This systematic review and meta-analysis was performed to investigate any association between PTS and ACL tears in the pediatric population. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review was performed to identify studies that examined the relationship between PTS, medial tibial slope (MTS), and lateral tibial slope (LTS) and ACL tears in children and adolescents aged ≤18 years. Full-text observational studies comparing PTS, MTS, and/or LTS values between pediatric (≤18 years of age) patients with and without ACL injury were included in this analysis. Review articles and case series were excluded. The authors calculated the mean difference (MD) via a restricted maximum-likelihood estimator for tau square and a Hartung-Knapp adjustment for random-effects model. RESULTS A total of 348 articles were identified in the initial database search, yielding 10 for final inclusion and analysis. There was no statistically significant association between PTS (MD, 1.13°; 95% CI, -0.55° to 2.80°; P = .10), MTS (MD, 0.36°; 95% CI, -0.37° to 1.10°; P = .27), or LTS (MD, 1.41°; 95% CI, -0.20° to 3.02°; P = .075) and risk for ACL injury in this population. CONCLUSION The current study found that unlike what has been shown in adult populations, increased PTS may not be a significant risk factor for ACL tears in pediatric and adolescent patents. LTS was the only measured parameter that neared statistical significance, perhaps suggesting a potential role for this measurement in determining ACL risk if further research is done in this population.
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Affiliation(s)
| | - Pratik Pradhan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Mininder S Kocher
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Shin CH, Syed AN, Swanson ME, Kushare IV, Shea KG, Ganley TJ, Baghdadi S, Cruz AI, Ellis HB, Fabricant PD, Ganley TJ, Green DW, Kerrigan A, Kirby J, Kocher M, Kushare IV, Jay Lee R, MacDonald JP, McKay SD, Parikh SN, Patel NM, Yen YM, Schmale GA, Shea KG, Justin Mistovich R. Evaluation of Tibial Slope on Radiographs in Pediatric Patients With Tibial Spine Fractures: An Age- and Sex-Matched Study. Orthop J Sports Med 2024; 12:23259671241256445. [PMID: 39100212 PMCID: PMC11295229 DOI: 10.1177/23259671241256445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 08/06/2024] Open
Abstract
Background A recent study has reported that the radiographic measurement of posterior tibial slope (PTS) is larger in male pediatric patients with tibial spine fractures (TSF) than in controls. However, they found no difference in PTS between female patients and controls. Purpose (1) To identify whether PTS is larger in female pediatric patients with TSF than in female controls and (2) to validate the relationship between PTS and pediatric TSF in male patients. Study Design Cross-sectional study; Level of evidence, 3. Methods After an a priori power analysis, 84 pediatric patients with TSF (50 female patients and 34 male patients) and 84 age- and sex-matched controls were enrolled in this study. Demographic information, including sex, age, and race, was recorded. Skeletal maturity was determined based on the stage of epiphyseal union on knee radiographs. PTS was defined as the angle between a line perpendicular to the longitudinal axis of the tibia and the posterior inclination of the medial tibial plateau on standard knee lateral radiographs. Results The mean age when the TSF occurred was 11.2 ± 2.7 years for female patients and 12.9 ± 2.5 years for male patients. There was no significant difference in skeletal maturity between female patients and female controls or between male patients and male controls. The mean PTS was not significantly different between female patients (8.8°± 2.8°) and female controls (8.3°± 3.1°) (P = .366) or between male patients (9.0°± 2.8°) and male controls (9.3°± 2.6°) (P = .675). Those with a PTS >1 SD (2.9°) above the mean (8.8°) had no greater odds (1.0 [95% CI, 0.4-2.5]; P≥ .999) of having a TSF than others. Conclusion PTS was not found to be a risk factor for pediatric TSF in female or male patients in this study.
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Affiliation(s)
- Chang Ho Shin
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akbar N. Syed
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Morgan E. Swanson
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Indranil V. Kushare
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin G. Shea
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - ASTEROID;
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J. Ganley
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Soroush Baghdadi
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aristides I. Cruz
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Henry B. Ellis
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter D. Fabricant
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J. Ganley
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W. Green
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alicia Kerrigan
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia Kirby
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mininder Kocher
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Indranil V. Kushare
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R. Jay Lee
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James P. MacDonald
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott D. McKay
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shital N. Parikh
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeraj M. Patel
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yi-Meng Yen
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory A. Schmale
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin G. Shea
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R. Justin Mistovich
- Investigation performed at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Almolla RM, Almalki YE, Basha MAA, Mohamed Farag MAEA, Metwally MI, Nada MG, Libda YI, Zaitoun MMA, Abdalla AAEHM, Yousef HY, Abd Elhamed ME, Elsheikh AM, Alduraibi SK, Eldib DB, Khater HM, Mahmoud HF, Elkayal ES, Alshehri SHS, Aldhilan AS, Basha AMA, Hassan HA. MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability. Acad Radiol 2024; 31:1480-1490. [PMID: 37914624 DOI: 10.1016/j.acra.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
RATIONALE AND OBJECTIVES Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.
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Affiliation(s)
- Rania Mostafa Almolla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia (Y.E.A.)
| | - Mohammad Abd Alkhalik Basha
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.).
| | | | - Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamad Gamal Nada
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yasmin Ibrahim Libda
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamed M A Zaitoun
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Ahmed A El-Hamid M Abdalla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Hala Y Yousef
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Marwa E Abd Elhamed
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Amgad M Elsheikh
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Diaa Bakry Eldib
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hamada M Khater
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hossam Fathi Mahmoud
- Department of Orthopedic Surgery and Traumatology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (H.F.M.)
| | - Engy S Elkayal
- Department of Radio-diagnosis, Faculty of Human Medicine, Fayoum University, Fayoum, Egypt (E.S.E.)
| | - Shaker Hassan S Alshehri
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (S.H.S.A.)
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Ahmed M A Basha
- Faculty of General Medicine, Tyumen State Medical University, Tyumen, Russian Federation (A.M.A.B.)
| | - Hanan A Hassan
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
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