The effect of the relationship of posterior tibialslope and patellar tendon orientation on ancientcross-ligate ruptureposterior tibial eğim

INTRODUCTION: Anterior cruciate ligament injury is one of the most common knee and knee ligament injuries. In such injuries, surgical treatment may be required depending on the age and physical condition of the patient. Many studies investigate the etiology and mechanism of anterior cruciate ligament (ACL) injury. There are studies showing an association between increased posterior tibial slope (PTE) and anterior cruciate ligament injury. However, the study investigating the relationship between both PTE and patellar tendon orientation (PTO) and ACL rupture has not been reviewed in the literature to the best of our knowledge. The aim of this study is to investigate the relationship of PTE and PTO with anterior cruciate ligament rupture. METHODS: Patients who were operated for ACL rupture in Necmettin Erbakan University Meram Medical Faculty Department of Orthopedics and Traumatology between 2015-2021 were analyzed retrospectively. Exclusion criteria of the study were medial and lateral meniscal tear, previous lower extremity surgery, neuromuscular and hematological diseases, lower extremity malalignment, (leg length inequality, coronal and sagittal plane deformities, patellar instability), degenerative arthritis (Kellgren Lawrance stage 2-3-4 ), patients without knee radiography suitable for radiological measurement were patients under the age of 18 and over the age of 50. A total of 160 patients were divided into 2 groups, consisting of 80 patients with standard knee lateral radiographs including the tibial shaft, suitable for radiological measurements, with knee MRIs, and isolated ACL rupture, and 80 patients with a similar distribution in terms of age and gender, with a normal knee image on MRI, as the control group. Person was included in the study. In our study, PTE measurements were made on full lateral radiographs containing the tibial shaft, with the femoral condyles exposed on each other; The angle between the tangent of the line passing over the medial plateau and the tibia anatomical viii axis was calculated by measuring. At the same time, patellar tendon length (the distance between tuberositas tibia and lower pole of the patella) and diagonal length of the patella were measured in the full lateral radiograph. The Insall-Salvati ratio was calculated by proportioning the patellar tendon length to the patella length. In addition, the tibial tilt-patellar tendon angle (TEPTA) between the line passing through the patellar tendon trace (tuberositas tibia-patella inferior pole) and the line tangent to the tibial plateaus was calculated. RESULTS: 47 (58.7%) of the patients with ACL rupture were male, 33 (41.3%) were female, and 44 (55%) of the control group patients were males and 36 (45%) were females. The mean PTE value of the patients with ACL rupture was 10.65º±1.91º, the mean PTE value of the control group patients: 9.52º±1.50º. The PTE values of the patients with ACL rupture were found to be significantly higher than the control group.(p=0.005) The insall-salvati ratio of the patient group with ACL rupture was found to be significantly lower than the control group.(p꞊0.043) The tibial slope patellar When the tendon angle (TEPTA) measurements were compared, the TEPTA value after the reconstruction was found to be significantly higher than the TEPTA measurements performed before the reconstruction. <0.001) DISCUSSION AND CONCLUSION: The most important finding of this study is that patellar tendon orientation may be associated wıth ACL rüptüre and Insall-Salvati ratio. When we examined the relationship between TEPTA and ACL rupture, the TEPTA of the patients who underwent ACL reconstruction was significantly higher than the group with ACL rupture and the control group. In this respect, our study showed that patellar tendon orientation may be associated with ACL rupture.