Anteroposterior Rotational References of the Tibia for Medial Unicompartmental Knee Arthroplasty in Japanese Patients

Tsukamoto, Ichiro; Akagi, Masao; Mori, Satoshi; Inoue, Shunsuke; Asada, Shigeki; Matsumura, Fuminori

doi:10.1016/j.arth.2017.04.052

Cited by 26 publications

(17 citation statements)

References 21 publications

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“…These lines are very useful for primary TKA in which the PCL is recognized directly. For primary medial unicompartmental knee arthroplasty, Tsukamoto et al showed that the line connecting the medial border of the patellar tendon at the articular surface level and the medial intercondylar tubercle was suitable as the tibial AP axis [23]. However, the above lines cannot be used for knees in which the PCL disappears due to severe in ammation or for revision TKA in which joint structures have already been resected.…”

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

View full text Add to dashboard Cite

show abstract

“…These lines are very useful for primary TKA in which the PCL is recognized directly. For primary medial unicompartmental knee arthroplasty, Tsukamoto et al showed that the line connecting the medial border of the patellar tendon at the articular surface level and the medial intercondylar tubercle was suitable as the tibial AP axis [ 23 ]. However, the above lines cannot be used for knees in which the PCL disappears due to severe inflammation or for revision TKA in which joint structures have already been resected.…”

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

BMC Musculoskelet Disord

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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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“…Tsukamoto et al have shown that the sagittal cut referencing the substitute AP line provides better AP rotation and tting of the tibia in UKA than referencing the medial intercondylar [11]. Because the substitute AP was more similar to the tibial APL and when the substitute AP was used as the reference axis of osteotomy, the ratio of transverse diameter and longitudinal diameter of the tibial osteotomy is closer to the current model of the prosthesis, which is a good reference mark for sagittal tibial osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the repeatability of the tibial component's rotation and positioning is low, and there remain many uncertainties in its rotation and alignment. According to the classic osteotomy method recommended by Oxford, 2-40% of the tibial components have poor alignment [11]. In UKA, the rotation alignment of sagittal tibial resection is always di cult.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a Novel Tibial Sighting Device Combined with Intramedullary Femoral Localisation on the Rotational Alignment of the Tibial Component for Oxford Unicompartmental Knee Arthroplasty

Chen¹,

Liu

Li³

et al. 2020

Preprint

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Background：The success of unicompartmental knee arthroplasty (UKA) depends on perfect prosthesis component alignment. However, it is difficult to identify the anteroposterior axis and implant components in the correct rotational position in a narrow operating field in a UKA. Thus, we invented a novel tibial sighting device and explored whether combining it with intramedullary femoral localisation could be feasible on the rotational alignment of the tibial component for the Oxford UKA.Methods: Twenty consecutive knees were treated with UKA using a novel tibial sighting device combined with intramedullary femoral localisation. An equal number of patients who underwent UKA with the conventional technique were matched to the control group. Radiographic accuracy was evaluated based on the implant position in the tibial CT transverse sections. The α angles were measured between the tibial component line and the vertical line of TEA', which was projected to the trans-epicondylar axis (TEA).Results: The absolute value of the test group’s α angle was significantly smaller than the respective values of the control group (P=0.006). The ratio of △α > 3° in the test group was also significantly smaller than that of the control group (P=0.048).Conclusion: The novel tibial sighting device combined with intramedullary femoral localisation provided the surgeon a better surgical view in sagittal tibial osteotomy and improved the accuracy of tibial implant alignment in UKA. This method makes the vertical osteotomy of the tibial platform simpler, more precise and highly repeatable.

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Anteroposterior Rotational References of the Tibia for Medial Unicompartmental Knee Arthroplasty in Japanese Patients

Cited by 26 publications

References 21 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 medial tangent of the proximal tibia is a suitable extra-articular landmark in determining the tibial anteroposterior axis

Feasibility of a Novel Tibial Sighting Device Combined with Intramedullary Femoral Localisation on the Rotational Alignment of the Tibial Component for Oxford Unicompartmental Knee Arthroplasty

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