Increased medial tibial slope is a possible risk factor for patellar cartilage lesions.

Introduction: Axial malalignment in the coronal plane has been identified as a significant risk factor for knee cartilage damage, leading to osteoarthritis progression. However, the impact of sagittal axial deviation on cartilage damage remains underexplored. Biomechanical studies have suggested that an increased tibial slope leads to altered pressure distribution in the articular cartilage, potentially contributing to cartilage damage. Despite these biomechanical insights, clinical evidence linking increased tibial slope to cartilage damage is lacking. Methods: This retrospective study focuses on patients who underwent surgical cartilage transplantation between January 2016 and July 2023. A total of 108 patients were divided into two groups based on the presence or absence of other pathologies contributing to cartilage damage. Clinical data, including tibial slope measurements from lateral radiographs, were collected. A further subgroup-matched pair analysis was conducted comparing cases with patellar lesions and healthy knees. Statistical analysis compared tibial slope values between groups and assessed correlations between tibial slope and cartilage lesion grade. Results: Patients without other identifiable pathologies exhibited a significantly higher medial tibial slope compared to those with known causative factors for cartilage damage ( Conclusion: The study identified increased medial tibial slope as a possible independent risk factor for cartilage damage in the knee, especially in the patellar region. Level of Evidence: Level IV.