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Agreement is evaluated using correlation, ICC, Bland–Altman, and Deming regression, with MRI thresholds benchmarked against XR ≥12°. Results show systematic XR overestimation (+1.8°), moderate concordance (ICC 0.506), and an optimal MRI cutoff of 8.8° (AUC 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0.506).",{"name":74,"@type":61,"acceptedAnswer":75},"What MRI cutoff corresponds to XR ≥12° for high slope?",{"text":76,"@type":64},"ROC analysis identified an optimal MRI cutoff of 8.8°, described as having excellent diagnostic accuracy (AUC = 0.841).","https://schema.org",{"og:url":32,"og:type":79,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":81,"canonical":32},"index,follow",{"doc_id":83,"site_id":7},461347,1791029136,{"code":4,"msg":86,"data":87},"success",[88,92,96,100,105,110,114,119,124,127,131],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Story & 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Pediatric Population  \nClémence Peufly 1,2, Lyes Chaal 1,2, Elie Chouffani 1,2, Romir Patel 3, Sebastien Pesenti 2, Matthieu Ollivier 1,2 and Antoine Piercecchi 1,2, *  \nAcademic Editor: Francesca Veronesi  \nReceived: 23 November 2025  \nRevised: 15 December 2025  \nAccepted: 18 December 2025  \nPublished: 22 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 13284 Marseille, France; [olliviermt@gmail.com](olliviermt@gmail.com) (M.O.)  \n2 Department of Biomechanics, Institute for Locomotion, St Marguerite Hospital, APHM, CNRS, ISM, Aix-Marseille University, 13284 Marseille, France  \n3 Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA  \n* Correspondence: [apiercecchi@gmail.com](apiercecchi@gmail.com)  \nAbstract  \nBackground/Objectives: Posterior tibial slope (PTS) is an established risk factor for anterior cruciate ligament (ACL) injury in adults. In pediatric population, this relation is less established, and the PTS measurement is not clearly defined. To determine the agreement between X-ray (XR) and magnetic resonance imaging (MRI) PTS measurements and to establish an MRI cutoff corresponding to the standard radiographic ≥12◦ definition of“high slope”. Methods: In this retrospective study, 108 adolescent knees with ACL rupture underwent paired XR and MRI evaluation by two reviewers. Agreement was assessed with Pearson and Spearman correlation, intraclass correlation coefficient (ICC), Bland–Altman analysis, and Deming regression. Diagnostic performance of MRI thresholds was compared with XR ≥ 12◦ as reference. Results: Mean PTS was higher on XR (10.2 ± 3.1◦ ) than on MRI (8.4 ± 2.8◦ ), with a systematic bias of +1.8◦ revealed by Bland–Altman analysis. These two measurements showed strong positive correlation (r = 0.602, p \u003C 0.001) and moderate concordance (ICC = 0.506, 95% CI, 0.186–0.696, p = 0.0015) . Individual differences ranged up to ±5◦ between modalities. Using XR ≥ 12◦ as reference for “high slope,” ROC analysis identified an optimal MRI cutoff of 8.8◦ with excellent diagnostic accuracy (AUC = 0.841, 95% CI, 0.760–0.922) . Conclusions: Radiographic measurements systematically overestimate PTS relative to MRI. Numeric thresholds are not interchangeable between modalities. An MRI cutoff of approximately 9◦ corresponds to the radiographic ≥12◦ definition of high slope and may serve as a pragmatic reference for interpreting MRI-based measurements in pediatric patients, requiring further validation.  \nKeywords: pediatric; posterior tibial slope; MRI measurement; ACL injury; ACL reconstruction  \n1. Introduction  \nPosterior tibial slope (PTS) is an important biomechanical factor contributing to knee joint stability [1] . Several studies have identified it as a key anatomical determinant influencing the risk of anterior cruciate ligament (ACL) injury and graft failure after ACL reconstruction in adults [2–4] . A steeper PTS has been associated with increased anterior tibial translation and greater mechanical stress on the ACL and subsequent ACL graft [4] . PTS is historically measured on lateral radiographs (XR), with a threshold of ≥12◦ frequently used to define a “high slope” in adults [5] . Several measurement techniques have been described using different anatomical landmarks such as the proximal tibial  \nsurface, the anterior or posterior cortical slope, and the anatomic or mechanical axis [6] . Alternative measurement methods have also been proposed using magnetic resonance imaging (MRI) or computed tomography (CT) [7] . All these methods show significant variability in the values obtained, and to our knowledge, no standardized cutoff curre","cbCaifSBUurrw5Ng","https://ap.wps.com/l/cbCaifSBUurrw5Ng","pdf",1218311,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction\n# Materials and Methods\n## Study Design and Population\n## Measurement Methods","[{\"question\":\"What was the main goal of comparing radiographic and MRI PTS measurements?\",\"answer\":\"To determine agreement between X-ray and MRI posterior tibial slope measurements in pediatric patients and to identify an MRI cutoff corresponding to the standard radiographic definition of a high slope (≥12°).\"},{\"question\":\"How was agreement between modalities assessed?\",\"answer\":\"Agreement used Pearson and Spearman correlation, intraclass correlation coefficient (ICC), Bland–Altman analysis, and Deming regression, with diagnostic performance of MRI thresholds evaluated against XR ≥12°.\"},{\"question\":\"What did the study find about differences between XR and MRI PTS values?\",\"answer\":\"Radiographic measurements systematically overestimated PTS compared with MRI, showing a mean difference of +1.8° and only moderate concordance (ICC = 0.506).\"},{\"question\":\"What MRI cutoff corresponds to XR ≥12° for high slope?\",\"answer\":\"ROC analysis identified an optimal MRI cutoff of 8.8°, described as having excellent diagnostic accuracy (AUC = 0.841).\"}]","Correlation Between Radiographic and MRI Posterior Tibial Slope Measurement on a Pediatric Population | PDF",1790761397,25]