The anteroposterior axis of the tibia in Korean patients undergoing total knee replacement

Kim, C. W.; Seo, Seung-Suk; Kim, J. H.; Roh, Sang-Myung; Lee, Chang-Rack

doi:10.1302/0301-620x.96b11.33794

Cited by 18 publications

(24 citation statements)

References 16 publications

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“…Since then, variants of this line have been reported [20,21]. Kim et al reported that the line connecting the anterior border of the proximal third of the tibia to the middle of the PCL was also perpendicular to the surgical epicondylar axis, and could also be used as the tibial AP axis [22]. These lines are very useful for primary TKA in which the PCL is recognized directly.…”

Section: Discussionmentioning

confidence: 99%

The Medial Tangent of the Proximal Tibia Is a Suitable Extra-articular Landmark in Determining the Tibial Anteroposterior Axis

Lee

Sumino

Suzuki³

et al. 2021

Preprint

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Background: Tibial rotational alignment in total knee arthroplasty (TKA) is generally determined based on intra-articular structure, and can be difficult to ascertain in some cases. The aim of this study was to investigate whether the medial tangent angle of the tibia (MTAT) could be useful in determining the anteroposterior axis of the tibia.Methods: This study was performed on 103 lower limbs in 53 patients who underwent primary total hip arthroplasty. The selection criteria for our study were based on the assumption that knees in patients undergoing THA exhibit fewer degenerative changes than knees in patients undergoing TKA. Using computed tomography images, the MTAT, comprising the medial tangent of the proximal tibia and the anteroposterior (AP) axis of the tibia, was measured on three horizontal planes: at the distal edge of the tibial tubercle (A), at 5 cm distally (B), and at 10 cm further distally (C). The tibial medial surface was grouped into three classes according to shape: valley type, flat type, and hill type. The percentage at which these shapes were observed in each group was also calculated. Measurement reliability was calculated using the intraclass correlation coefficient.Results: The angles were 45.2° (interquartile range: IR 43.0-47.7) at A, 42.7° (IR 38.7-45.9) at B, and 42.4° (IR 38.2-45.9) at C. Intra-rater reliability and inter-rater reliability was 0.982 and 0.974 at A, 0.810 and 0.411 at B, and 0.940 and 0.811 at C, respectively. Regarding the tibial medial surface, the valley type was observed in all cases at A, and the hill type was observed in the highest percentage of cases at B and C.Conclusions: The MTAT was approximately 45° at level A, and reproducibility was the highest among the three groups. The two points forming the valley on the tibial medial surface were bony ridges. Therefore, the medial tangent of the tibia at level A could be easily determined. Because the distal edge of the tibial tubercle exists at the surgical area and the extra-articular area, it can be a suitable intraoperative, extra-articular landmark in determining the tibial AP axis, even for revision TKA.

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Section: Discussionmentioning

confidence: 99%

The Medial Tangent of the Proximal Tibia Is a Suitable Extra-articular Landmark in Determining the Tibial Anteroposterior Axis

Lee

Sumino

Suzuki³

et al. 2021

Preprint

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“…Measurements confirmed its trend toward external rotation, which reaches approximately 10 AE 4.2, 10.3 AE 3.6, and 7.5 AE 5 degrees in Japanese, Chinese, and Korean populations, respectively. 8,21,22 In Caucasian subjects, a study reported that in 86% of 115 knees, the ML distance of the AP axis of the tibial component from the MTTTwas 2 mm or more, which caused a clinically meaningful error in rotation of 5 degrees or more. 23 Our study results are consistent with these findings because they show an average external rotation of 17.3 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…The mean angle between the AP axis of the tibia and the Akagi line was 0 AE 2.8, 0.1 AE 2.7, and -1.5 AE 4.3 degrees in Japanese, Chinese, and Korean populations, respectively. 8,21,22 But its accuracy is controversial. In 70% of the 115 knees of Caucasians, the ML distance of the AP axis of the tibial component to the medial border of the tibial tubercle was 2 mm or greater.…”

Section: Discussionmentioning

confidence: 99%

The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

Fang

Cheng

et al. 2019

J Knee Surg

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Rotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterior (AP) axis of the tibial tray was marked. The angles between the TEA and these lines were calculated, and the statistical differences were analyzed. The angle between the TEA and the Akagi line and between the TEA and the line connecting the medial third of the tibial tubercle with the midpoint of the PCL were 96.90 ± 5.57 and 107.31 ± 5.95 degrees, respectively. The angles between the TEA and the AP axis of the symmetrical and the asymmetrical design tibial trays were 94.01 ± 4.21 and 96.65 ± 4.70 degrees, respectively. Except for the Akagi line and AP axis of the asymmetrical tibial tray, statistical differences were found between all lines (p < 0.05). The PLCL technique is principally suitable for Chinese patients requiring TKA when using the tibial component referred to in this study, although it may result in slight external rotation.

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“…As previously mentioned, Akagi’s line passes through the midpoint of PCL at the height of the original joint surface and the medial edge of the patellar tendon at their respective tibial attachments (Fig 3) [5–8]. We defined 1/3 Akagi’s line as the line passing through the midpoint of PCL at the height of the original joint surface and the medial third of the patellar tendon at their respective tibial attachments (Fig 4) [8,11–13]. We defined the ATR line as the line passing through the lateral edge of PCL at its tibial attachment after tibial resection and the prominent point of the tibial tubercle (Figs 5 and 6).…”

Section: Methodsmentioning

confidence: 99%

A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty

et al. 2018

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PurposeDuring total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi’s lines.Materials and methodsIn this case–control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi’s line and the ATR line (ATR line angle) as well as between Akagi’s line and 1/3 Akagi’s line (1/3 Akagi’s line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle and ATR line angle were analyzed by two surgeons.ResultsWe found that 1/3 Akagi’s line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi’s line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34–0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839.ConclusionsThe ATR line was positioned between Akagi’s line and 1/3 Akagi’s line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection.

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The anteroposterior axis of the tibia in Korean patients undergoing total knee replacement

Cited by 18 publications

References 16 publications

The Medial Tangent of the Proximal Tibia Is a Suitable Extra-articular Landmark in Determining the Tibial Anteroposterior Axis

The Medial Tangent of the Proximal Tibia Is a Suitable Extra-articular Landmark in Determining the Tibial Anteroposterior Axis

The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty

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