Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study

Steinbrück, Arnd; Schröder, Christian; Woiczinski, Matthias; Müller, Tatjana; Müller, Peter E.; Jansson, Volkmar; Fottner, Andreas

doi:10.1007/s00167-015-3503-1

Cited by 52 publications

(54 citation statements)

References 45 publications

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“…Rotation alignment between the femoral and tibial components is extremely important for the success of total knee arthroplasty (TKA). Rotation malalignment can result in the development of symptoms such as anterior knee pain [1], poor patellar tracking [1,2], instability of knee flexion [1,3], and premature wear of polyethylene liner [1,4].…”

Section: Introductionmentioning

confidence: 99%

Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis

Ren

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: Consensus on tibial rotation in total knee arthroplasty (TKA) remains controversial. The present study aimed to investigate the closest anatomical reference to surgical epicondylar axis (SEA) among 10 tibial markers in Chinese adults. Methods: This study included examination of 122 normal lower extremities. Briefly, 10 axes were drawn on the axial sections: transverse axis of tibia (TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1/3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle (MBTT), and axis of anterior border of the tibia 1-4 (ATC1-4). The mean angles between TAT and SEA and that between other axes and the line perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined by applying one-way analysis of variance (ANOVA) and paired t-test. Results: In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes were compared to the line perpendicular to the projected SEA and found to be 10.2 ± 5.1°,

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Section: Introductionmentioning

confidence: 99%

Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis

Ren

Liu

et al. 2020

BMC Musculoskelet Disord

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“…Patellar component malalignment is related to increased retropatellar loading and abnormal patellar kinematics [15,16]. Regarding the high number of intraoperative parameters, the dynamic interplay of the articulating joint partners of PF and tibiofemoral joint need to be analyzed in a systematic and reproducible manner [15,17,18].…”

Section: Introductionmentioning

confidence: 99%

“…Despite improvements in surgical instruments and techniques, many of the causes of revisions and patient dissatisfaction are directly related to implant component malalignment [6,18,21,22]. The morphology of the knee joint differs between both genders and different ethnicities [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…In this regard, Chen et al [29] showed that the internal rotation of the femoral component and the varus malpositioning of the tibial component led to unfavorable postoperative loading conditions. Moreover, the malpositioning of the implant components often results in the overloading of the articulating joint compartments [18,30,31]. Different designs (dome-shaped, modified dome or anatomic design) and positions of the patellar button have been shown to affect knee joint dynamics [6,28,[32][33][34][35][36][37]].…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Kebbach

Darowski

Krueger³

et al. 2020

Materials

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Patellofemoral (PF) disorders are considered a major clinical complication after total knee replacement (TKR). Malpositioning and design of the patellar component impacts knee joint dynamics, implant fixation and wear propagation. However, only a limited number of studies have addressed the biomechanical impact of the patellar component on PF dynamics and their results have been discussed controversially. To address these issues, we implemented a musculoskeletal multibody simulation (MMBS) study for the systematical analysis of the patellar component’s thickness and positioning on PF contact forces and kinematics during dynamic squat motion with virtually implanted unconstrained cruciate-retaining (CR)-TKR. The patellar button thickness clearly increased the contact forces in the PF joint (up to 27%). Similarly, the PF contact forces were affected by superior–inferior positioning (up to 16%) and mediolateral positioning (up to 8%) of the patellar button. PF kinematics was mostly affected by the mediolateral positioning and the thickness of the patellar component. A medialization of 3 mm caused a lateral patellar shift by up to 2.7 mm and lateral patellar tilt by up to 1.6°. However, deviations in the rotational positioning of the patellar button had minor effects on PF dynamics. Aiming at an optimal intraoperative patellar component alignment, the orthopedic surgeon should pay close attention to the patellar component thickness in combination with its mediolateral and superior–inferior positioning on the retropatellar surface. Our generated MMBS model provides systematic and reproducible insight into the effects of patellar component positioning and design on PF dynamics and has the potential to serve as a preoperative analysis tool.

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“…Results : In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes compared to perpendicular of projected SEA were 10.2±5.1°, 1.4±5.0°, 11.9±5.4°, 3.6±4.8°, 12.0±6.9°, 7.2±8.6°, 7.1±10.4°, and 6.6±13.5° external rotation, respectively, and the MEPT axis was 1.6±4.5° internal rotation. The TAT was 4.1±5.3° external rotation compared to SEA.…”

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confidence: 98%

A CT study of tibiofemoral rotation alignment in normal knee joint of Chinese adult

Lu¹,

Ren²,

Liu³

et al. 2020

Preprint

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Background : Tibial rotation in total knee arthroplasty remains controversial. The aim was to investigate which anatomical reference was closer to SEA in 10 tibial markers in Chinese adult. Methods : The study included 122 normal lower extremities. 10 axes were drawn on the axial sections: transverse axis of tibia(TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1⁄3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle(MBTT)，axis of anterior border of the tibia 1-4(ATC1-4). The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using one-way ANOVA and paired t-test. Results : In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes compared to perpendicular of projected SEA were 10.2±5.1°, 1.4±5.0°, 11.9±5.4°, 3.6±4.8°, 12.0±6.9°, 7.2±8.6°, 7.1±10.4°, and 6.6±13.5° external rotation, respectively, and the MEPT axis was 1.6±4.5° internal rotation. The TAT was 4.1±5.3° external rotation compared to SEA. The M1⁄3 and Insall line were significantly externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. There was no significant difference between the TAT axis and the MBTT axis, as well as no significant difference between the ATC2, ATC3, and ATC4 axes. Conclusion : Akagi line, MBTT and TAT show good consistency with SEA in axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also has good alignment consistency with SEA in axial femorotibial alignment, it can be reliable reference mark for rotational alignment of the tibial component in TKA.

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Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study

Abstract: Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.

Cited by 52 publications

References 45 publications

Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis

Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

A CT study of tibiofemoral rotation alignment in normal knee joint of Chinese adult

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