Measurement of posterior tibial slope in north Indian population in relation to squatting

Vol 35 | Issue 2 | May-Aug 2020 | page: 14-18 | Khalid Ahmad Qidwai¹, Shakeel Ahmad Qidwai²

Authors: Khalid Ahmad Qidwai¹, Shakeel Ahmad Qidwai²

¹King George Medical University, Lucknow, UttarPradesh,India.
²Department of Orthopedics Surgery, Era’s University, Lucknow, UttarPradesh,India.

Address of Correspondence:
Dr. Khalid Ahmad Qidwai,
King George Medical University, Lucknow, UttarPradesh,India.


Background: Tibial plateau, proximal tibial surface, has a slope directed postero-inferiorly relative to the long axis of the middle of the shaft. It has important consideration in surgeries such as knee arthroplasty, high tibial osteotomy, and medical imaging of the knee joint [1]. The aim of the present study was to estimate the Posterior Tibial Slope (PTS) by plain radiograph in the adult Northern Indian population with respect to lifestyle depending upon the squatting habit. It has significance in antero-posterior stability of the knee joint [2]. The current study aims to measure the Posterior Tibial slope in North Indian people and compare the PTS among the groups of people who squat and who do not squat in their day to day activities and draw a conclusion if it has a clinical significance in range of flexion of knee joint in knee arthroplasty.
Material and Method: this study was conducted at the Department of Anatomy, King George Medical University, Lucknow in collaboration with Department of Orthopaedics, Era University Lucknow. Measurements were taken in 37 patients on X-rays with a mean age of 46.5 years. Of the total subjects, 22 were squatters and 15 are non-squatters. Total of 70 X-rays (Knee Joint-Lateral View) were taken in which 43 X-rays were of squatters and 27 X-rays were of non-squatters with 34 X-Rays of left Side and 36 X-rays of right side. (Master Chart enclosed). Reference line taken to measure PTS was Posterior Tibial Cortex (PTC). A line was drawn tangential to PTC. Another line was drawn perpendicular to the first line passing through the anterior most point of the tibial slope. Then a line was drawn tangential to the tibial slope and the PTS was then measured by a protractor.
Results: PTS of non-squa_ers came out to be 9.25°±2.99 while those of squatters 11.67°±2.82. Average PTS was 10.74°±3.1° with 10.08°±3.28 in the left knee and 11.36°±2.83 in the right knee.
Conclusion: The present study described the variation of PTS in north Indian population (Uttar Pradesh) which came out to be 10.74°±3.1°. The PTS of squatters was 11.6°±2.82° and that of non-squatters 9.25°±2.99°. This difference in values of PTS is statistically significant (P=0.0011). Poor or no correlation of PTS was found with age and sex. The difference in PTS values in left and right knee was found to be statistically insignificant (P=0.0844). It may be concluded that in this pilot study squatting has been found to be significant as a cause of increased PTS which may be considered as an indicator for designing TKA implants which accommodate the increased PTS to increase range of flexion. However, authors do recommend MRI/CT Scan based prospective studies on measurement of preoperative PTS and its significance on maximal angle of flexion in post TKA knee joints.
Keywords: Tibial slope, Squatting, Knee arthroplasty.


1. Genin P, Weill G, Julliard R. The tibial slope. Proposal for a measurement method. J Radiol. 1993;74(1):27–33.
2. Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF. The association between posterior-inferior
tibial slope and anterior cruciate ligament insufficiency. Arthroscopy. 2006;22:894–899.
3. Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg 1977; 59-A(1): 77- 9.
4. Robert Giffin, J., Vogrin, T. M., Zantop, T., Woo, S. L.-Y., & Harner, C. D. (2004). Effects of Increasing Tibial Slope on the Biomechanics of the Knee. The American Journal of Sports Medicine, 32(2), 376–382.
5. Campbell’s Operative Orthopedics, 9th Edition, Page 235.
6. Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture: two radiological tests compared. J Bone Joint Surg Br. 1994;76:745–749.
7. Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86:506–511.
8. Kim KC, Choi JY, Kim JS, Chung HJ, Koo BS, Won SY. Influence of the posterior slope of the tibial component on the maximal flexion after total knee arthroplasty. J Korean Knee Soc. 1998;10:13–17.
9. Piazza SJ, Delp SL, Stulberg SD, Stern SH. Posterior tilting of the tibial component decreases femoral rollback in posteriorsubstituting knee replacement: a computer simulation study. J Orthop Res. 1998;16:264–270.
10. Singerman R, Dean JC, Pagan HD, Goldberg VM. Decreased posterior tibial slope increases strain in the posterior cruciate ligament following total knee arthroplasty. J Arthroplasty. 1996;11:99–103.
11. Hernigou P, Deschamps G, Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. [J Bone Joint Surg Am. 2004 Mar; 86(3):506- 11]
12. Karimi E, Norouzian M, Birjandinejad A, Zandi R, Makhmalbaf H. Measurement of Posterior Tibial Slope
Using Magnetic Resonance Imaging. Arch Bone Jt Surg. 2017;5(6):435–439.
13. Campbell W, Canale ST, Beaty JH. Campbell’s operative orthopaedics. 11th ed. Philadelphia: Mosby, Elsevier; 2008.
14. Insall JN. Surgical techniques and instrumentation in total knee arthroplasty. Surg Knee. 1993;43(2):739–804
15. Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426(1):180–6.
16. Seo JG, Moon YW, Kim JH. Influence of posterior tibial slope on stability after total knee arthroplasty. J Korean Knee Soc. 2007;19(2):218–24.
17. Kim KH, Bin SI, Kim JM. The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty. Knee Surg Relat Res. 2012;24(3):158–163. doi:10.5792/ksrr.2012.24.3.158
18. Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A. Evaluation of methods for radiographic
measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 1996;82:195-200
19. Didia BC, Jaja BN. Posterior slope of tibial plateau in adult Nigerian subjects. Int J Morphol. 2009;27:201–4.
20. Moore TM, Harvey JP Jr. Roentgenographic measurement of tibial-plateau depression due to fracture. J Bone Joint Surg Am 1974;56:155-60.
21. Matsuda S , , Miura H , Nagamine R , Urabe K , Ikenoue T , Okazaki K , Iwamoto Y The American Journal of Knee
Surgery [01 Jan 1999, 12(3):165-168]
22. Mohanty SS, Rao NN, Dash KK, Bhosale SK. Correlation of posterior tibial slope with metaphysio-diaphyseal angle in total knee arthroplasty: a radiological study. Indian J Orthop. 2013;47(1):67–71.
23. J.M. Muthuuri, Determination of posterior tibial slopeand slope detoriation with osteoarthritis: A radiological study in African Population , Vol. 8: March 2014
24. Medda S, Kundu R, Sengupta S, Pal AK. Anatomical variation of posterior slope of tibial plateau in adult Eastern
Indian population. Indian J Orthop 2017;51:69-74
25. Nekkanti S, Patted P, Nair LM, Chandru V, Shashank G. The variation of the posterior tibial slope in South Indians: A hospital-based study of 290 cases. Niger J Orthop Trauma 2018;17:17-21
26. 26.Bisicchia S, Scordo GM, Prins J, Tudisco C. Do ethnicity and gender influence posterior tibial slope?. J Orthop
Traumatol. 2017;18(4):319–324. doi:10.1007/s10195- 017-0443-1
27. 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;23:586-92.
28. Utzschneider, S., Goettinger, M., Weber, P. et al. Development and validation of a new method for the radiologic
measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19, 1643–1648 (2011).
29. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res. 2009;467(8):2066–2072. doi:10.1007/s11999-009-0711-3
30. Dehghan M, Bahmani MT. Anatomical parameters associated with osteoarthritis of the knee joint. Armaghane Danesh. 2014;19(5):462–9.

How to Cite this Article: Qidwai KA, Qidwai SA | Measurement of posterior tibial slope in north Indian population in relation to squatting | Journal of Bone and Joint
Diseases | May-Aug 2020;35(2):14-18.

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