Editorial Commentary: Increased Tibial Slope Is Associated With Anterior Cruciate Ligament Injury Risk, and Tibial Slope Increases in the Skeletally Immature, Anterior Cruciate Ligament-Deficient Knee: A Chicken or Egg Causality Dilemma?

Abstract

Increased tibial slope is associated with increased risk of anterior cruciate ligament (ACL) injury in the skeletally immature. Recent studies, however, emphasize a mutual influence, as tibial slope has been shown to increase over time in the ACL-deficient skeletally immature knee. It is hypothesized that altered biomechanics with enhanced posterior force transmission in the ACL-deficient knee may influence the developing physis, leading to altered longitudinal growth and increased tibial slope. In addition to tibial slope, the meniscal geometry, including meniscal bone angle and meniscal slope, have been shown to influence the risk of ACL injury. In the skeletally immature knee, especially, the soft tissue geometry is thought to have significant impact on ACL injury risk. However, it remains unknown whether alteration of the meniscal slope may represent a causality of ACL deficiency.