Normal anatomical variations of tibial plateau geometry in Indian population: a magnetic resonance image-based study

Gopal Ghosh, Shabarna Roy


Background: Geometry of tibial plateau characterized by its medial tibial plateau slope (MTS), lateral tibial plateau slope (LTS), depth of concavity of medial tibial plateau (CMT), convexity of lateral tibial plateau on sagittal section and coronal tibial plateau slope (CTS) on coronal section of tibia.

Methods: 500 subjects (male-250, female-250) were included in the study. Various tibial slopes of each subject were measured using magnetic resonance image (MRI) of knee joint. Data was analysed using appropriate statistical analysis.

Results: When considering male and female one group (total population) mean (±SD) of MTS, LTS, CMT, CTS were 7.73±3.200, 4.68±2.750, 2.56±0.56 mm and 2.61±2.150 respectively. In male population mean (±SD) of MTS, LTS, CMT, CTS were 6.94±3.20, 3.77±1.850, 2.7±0.55 mm, 3.06±2.390 respectively. In female population population mean (±SD) of MTS, LTS, CMT, CTS were 9.28±2.650, 6.45±3.360, 2.28±0.48 mm, 1.75±1.240 respectively. Over all MTS and LTS was poorly correlated (r=0.43). Female had significant steeper MTS (p=0.013) and LTS (p=0.001) but had less CTS (p=0.04) and shallow CMT (p=0.012) compared to male.

Conclusions: Knowledge of this study could be used in different operative orthopaedic procedures (like knee arthroplasty, high tibial osteotomy, tibial plateau fracture fixation), non-contact ACL injury risk assessment.



Geometry of tibial plateau, Various slopes, Total knee replacement

Full Text:



Hashemi J, Chandrashekar N, Gill B, Beynnon B, Slauterbeck J, Schutt Jr. RC, Mansouri H et al. The Geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surgery Am. 2008;90:2724-34.

Genin P, Weill G, Julliard R. The tibial slope. Proposal for a measurement method. J Radiol. 1993;74:27-33.

Khattak MJ, Umer M, Davis ET, Habib M, Ahmed M. Lower limb alignment and posterior tibial slope in Pakistan, a radiological study. J Orthop Surg. 2010;18(1):22-5.

Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999;12:165-8.

Khan MS, Seon JK, Song EK. Risk factors for anterior cruciate ligament injury: assessment of tibial plateau anatomic variables on conventional MRI using a new combined method. Int Orthop. 2011;35:1251-6.

Moore TM, Harvey JP Jr. Roentgraphic measurement of tibial plateau depression due to fracture. J Bone joint Surg Am. 1974;56(1):155-60.

Didia BC, Jaja BNR. Posterior Slope of Tibial Plateau in Adult Nigerian Subjects. Int j morphol. 2009;27(1):201-4.

Titze A. Die variationen der Nwigung der Schienbeinkopfgelenkflache. Z Orthopa”d. 1951;80:437-44.

Kate BR, Robert SL. Some observations on the upper end of the tibia in squatters. J Anat Lond. 1965;99(1):137-41.

Vyas S, Van Eck CF, Vyas N, Fu FH, Otsuka. Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries. NY Knee Surg Sports Traumotol Arthrose. 2010.

Yoga R, Sivap Athasundaram N, Suresh. Posterior slope of the tibial plateau in Malaysian patients undergoing total knee replacement. Malaysian Orthop J. 2009;3(1):78-80.

Mohanty SS, Rao N, Dash KK, Bhosale SK. Correlation of posterior tibial slope with metaphysiodiaphyseal angle in total knee arthroplasty, A radiological study. Indian J Orthop. 2013;47(1):67-71.

Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994;76:745-9.

Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc. 1984;184:564-9.

Dejour H, Walch G, Chambat P, Ranger P. Active subluxation in extension. Am J Knee Surg. 1988;1:204-11.

Stijak L, Herzog RF, Schai P. Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):112-7.

Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech. 2010;43(9):1702-7.

Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR et al. Beynnon; Shallow Medial Tibial Plateau and Steep Medial and Lateral Tibial Slopes: New Risk Factors for Anterior Cruciate Ligament Injuries. Am J Sports Med. 2010;38(1);54-62.

Rohr WL Jr, Hungerford DS. Primary total knee arthoplasty, Chapter 136, Operative orthopedics vol. 3, 2nd Edition, 1993; Edited by Chapman MW and Madison M, Published by J. B Lippinco company, 227 East Washing ton Square, Philadelphia, Pennsylvania. 1996;1968.

Hernigou P, Deschamps G. Posterior slope of tibial plateau and outcome of uniocompartmental knee arthroplasty. J bone joint surg. 2004;86:506-11.

Walker PS, Garg A. Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Relat Res. 1991;262:227-35.

Hernigou P, Deschamps G. Posterior slope of tibial plateau and outcome of uniocompartmental knee arthroplasty. J bone joint surg. 2004;86:506-11.

Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK. Anatomical References to Assess the Posterior Tibial slope in Total Knee Arthroplasty, A Comparison of 5 Anatomical Axes. J Arthroplasty. 2008;23(4):586-92.

Brazier J, Migaud H Gougeon F, Cotton A, Fontaine C, Duquennoy A. Evalution of tibial slope radiographic methods; analysis of healthy knees. Rev Chir Orthop Reparatrice. 83 Appar Mot. 1996;82:7-13.