A morphometric study of the tibial plateau slope and depth in a South African population

Maintenance of lower limb alignment is important during
surgeries involving the knee. For example, several studies have demonstrated
that a higher posterior tibial plateau slope (PTPS) is a risk factor for
anterior cruciate ligament (ACL) injuries. Furthermore, a PTPS ≥ 12° is a risk
factor for failure of anterior cruciate ligament reconstruction.
Population-specific and sex-specific differences have been reported on the PTPS
in relation to different axes. Only a few studies have examined the potential
risk factors associated with the geometry of the tibial plateau in relation to
anterior and posterior cruciate ligament injuries. Knowledge of the PTPS, as
well as the medial tibial plateau depth (MTPD), may benefit clinicians in
identifying patients that may be at increased risk of graft failure following
ACL reconstruction surgeries and in screening patients that may be at greater
risk for cruciate ligament injuries.

As such, the PTPS in relation to the anterior tibial cortex
axis (ATCA), proximal tibial anatomical axis (PTAA), and posterior tibial
cortex axis (PTCA) were studied on radiographs. A sample of 480 lateral knee
radiographs was examined to determine the PTPS slopes. Significant differences
were only observed between weight bearing and non-weight bearing radiographs
for White females (p = 0.035) when comparing the PTPS in relation to the ATCA
(PTPS-ATCA) measurements. No sexual dimorphism or population differences were
observed for the PTPS (p ≥ 0.05). Significant differences were observed between
the PTPS -ATCA, PTPS in relation to the PTAA (PTPS-PTAA), and PTPS in relation
to the PTCA (PTPS-PTCA) (p < 0.001). The age of an individual was
insignificantly weakly correlated to the PTPS in relation to the ATCA (r =
0.074; p = 0.104), PTAA (r = 0.031; p = 0.499), and PTCA (r = -0.018; p =
0.686).

The MTPD was studied on an osteological sample consisting of
the bilateral

examination of the tibiae of 59 individuals. No bilateral
asymmetry was observed in the MTPD (p ≥ 0.05). The MTPD was shown to be
sexually dimorphic (p < 0.05) for both Black and White individuals.
Population differences were observed when

comparing males and females respectively for Black (p = 0.001)
and White individuals (p < 0.001). The MTPD was found to be weakly
correlated to the age (r = 0.066; p = 0.478), stature (m) (r = 0.204; p =
0.035), weight (kg) (r = 0.209; p = 0.031) and body mass index (BMI) (kg/m2) (r
= 0.115; p = 0.242) of an individual. The correlations between the MTPD and the
stature (m) and weight (kg) of an individual was significant (p < 0.05).

Fractures made up 73% of diagnoses made in the category of
traumatic injuries of

bone. Ligament and meniscus pathologies were observed in 59%
of patients

presenting with traumatic conditions of soft tissues. The
largest proportion of patients diagnosed with degenerative conditions presented
with osteophytosis (33%). A very small proportion of patients presented with
dislocations and subluxations (n = 4). 63% of patients diagnosed with
conditions related to the patella, patellofemoral joint and knee joint
presented with knee joint narrowing. The largest proportion of surgical
interventions consisted of knee replacements (51%). A small sample (n = 43) of
observations was made regarding knee joint configuration.

The PTPS-ATCA, PTPS-PTAA, and PTPS-PTCA was shown to be
highly variable in

the South African population. A significant difference was
observed between weight bearing and non-weight bearing radiographs in the White
female sample (p = 0.035). This difference, however, was small and may not be
clinically relevant. No populationspecific or sex-specific differences were
observed in the PTPS-ATCA, PTPS-PTAA, or PTPS-PTCA. Significant differences
were observed for the PTPS-ATCA, PTPS-PTAA, and PTPS-PTCA in the South African
population (p < 0.001). Sexual dimorphism exists for the MTPD in the Black
and White South African populations with a greater depth of concavity being
observed in males than in females (p = 0.001 [Black population] and p < 0.001 [White population]). No population-specific differences were observed for
the MTPD when White and Black populations were compared for females (p = 0.768)
or males (p = 0.633).

在涉及膝关节的手术过程中，维持下肢对线至关重要。例如，多项研究表明，较高的胫骨后平台斜率（PTPS）是前交叉韧带（ACL）损伤的风险因素。此外，PTPS≥12°是前交叉韧带重建失败的风险因素。关于PTPS与不同轴的关系，已有报道指出存在种群和性别特异性差异。仅有少数研究考察了与前后交叉韧带损伤相关的胫骨平台几何形状的潜在风险因素。了解PTPS以及内侧胫骨平台深度（MTPD），可能有助于临床医生识别ACL重建手术后可能存在移植物失败风险的病人，以及在筛选可能存在交叉韧带损伤更高风险的病人方面提供帮助。

因此，对X光片上的PTPS与胫骨前皮质轴（ATCA）、近端胫骨解剖轴（PTAA）和胫骨后皮质轴（PTCA）进行了研究。对480张膝关节侧位X光片进行了检查，以确定PTPS斜率。仅在白人女性（p=0.035）的承重和非承重X光片之间观察到PTPS与ATCA（PTPS-ATCA）测量值之间存在显著差异。未观察到PTPS的性别二态性或种群差异（p≥0.05）。PTPS-ATCA、PTPS与PTAA（PTPS-PTAA）和PTPS与PTCA（PTPS-PTCA）之间存在显著差异（p<0.001）。个体年龄与PTPS-ATCA、PTAA和PTCA的相关性不显著（r=0.074；p=0.104）、（r=0.031；p=0.499）和（r=-0.018；p=0.686）。

在由59名个体组成的骨骼样本上研究了MTPD，未观察到MTPD的双侧不对称性（p≥0.05）。MTPD在黑人和白人个体中均表现出性别二态性（p<0.05）。在比较黑人和白人男性（p=0.001）和女性（p<0.001）时观察到种群差异。MTPD与个体年龄（r=0.066；p=0.478）、身高（m）（r=0.204；p=0.035）、体重（kg）（r=0.209；p=0.031）和体质指数（BMI）（kg/m2）（r=0.115；p=0.242）呈弱相关。MTPD与个体身高（m）和体重（kg）之间的相关性显著（p<0.05）。

在骨骼损伤的创伤性损伤类别中，骨折构成了诊断的73%。在软组织创伤条件下，59%的患者观察到韧带和半月板病变。诊断为退行性病变的最大比例的患者表现出骨赘形成（33%）。极少数患者（n=4）表现出脱位和半脱位。63%诊断为髌骨、髌股关节和膝关节相关条件的患者表现出膝关节狭窄。最大比例的手术干预措施为膝关节置换术（51%）。对膝关节结构进行了关于43例观察的小样本研究。

PTPS-ATCA、PTPS-PTAA和PTPS-PTCA在南非人群中表现出高度可变性。在白人女性样本中，承重和非承重X光片之间观察到显著差异（p=0.035）。然而，这种差异很小，可能不具有临床意义。在PTPS-ATCA、PTPS-PTAA或PTPS-PTCA中未观察到种群特异性或性别特异性差异。在南非人群中，PTPS-ATCA、PTPS-PTAA和PTPS-PTCA之间存在显著差异（p<0.001）。在黑人和白人南非人群中，MTPD存在性别二态性，男性的凹陷深度大于女性（p=0.001[黑人种群]和p<0.001[白人种群]）。当比较白人和黑人的女性（p=0.768）或男性（p=0.633）时，在MTPD中未观察到种群特异性差异。