Knee functional flexion axis in osteoarthritic patients: comparison in vivo with transepicondylar axis using a navigation system

Colle, Francesca; Bignozzi, S.; Lopomo, N.; Zaffagnini, Stefano; Sun, Lei; Marcacci, Maurilio

doi:10.1007/s00167-011-1604-z

Cited by 32 publications

(30 citation statements)

References 54 publications

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“…Various approaches, including the kinematical analysis, the intra-operative analysis combined with the navigation, and the imaging analysis of the plain radiograph, CT, and magnetic resonance imaging, have been performed [8,14,16,18,21]. However, most of the reports related to the distal femur and the TEA were performed on Caucasian populations, while the present report is mostly restricted to an Asian population.…”

Section: Discussionmentioning

confidence: 95%

“…The radiuses of the medial and lateral circles were 26.0 ± 2.0 mm and 22.8 ± 2.4 mm, respectively. Colle et al [16] performed the intra-operative analyses of the functional flexion axis (FFA) orientation using a navigation system and compared the angle between the TEA and the FFA. In 111 arthritic knees, the average difference between the TEA and FFA was −2.8 ± 5.0°on the frontal plane and 0.6 ± 4.7°on the axial plane, suggesting that the FFA corresponds to the TEA for patients with OA on the axial plane.…”

Section: Discussionmentioning

confidence: 99%

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Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Kobayashi

Akamatsu

Kumagai

et al. 2015

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Kobayashi

Akamatsu

Kumagai

et al. 2015

The Journal of Arthroplasty

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“…Rotational alignment of the femoral component would be close to the SEA when it is adjusted to the tibial cut surface with proper MCL tension [2]. Moreover, the SEA is a functional flexion-extension axis and considered an anatomic basis of the coronal plane of the knee reference [8,9,14,20,29], although the reliability of the SEA measurement has not been proven [3,5]. We believe the AP axis of the tibia described by Akagi et al [1] is the appropriate rotational reference of the tibia.…”

Section: Discussionmentioning

confidence: 98%

“…Theoretically, there is no rotational mismatch between the femoral and tibial components in extension when surgeons use the AP axis as the rotational reference of the tibia. Additionally, the AP axis is perpendicular to the coronal plane of the knee when the coronal plane is considered as the plane parallel to the SEA [9,20,21,35]. It is not easy to identify the AP axis during a UKA, especially when using the tibia first-cut technique.…”

Section: Discussionmentioning

confidence: 99%

“…Yoshioka et al [35] suggested that the SEA is the functional transverse axis of the knee, and some authors have considered the coronal plane of the knee as the plane parallel to the SEA in their studies [9,20]. The sagittal cut of the tibia should then be made perpendicular to the SEA when the coronal plane is considered as the plane parallel to the SEA.…”

Section: Introductionmentioning

confidence: 99%

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Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Kawahara¹,

Matsuda²,

Okazaki³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique. Questions/purposes We explored whether the medial wall of the intercondylar notch could be useful for the tibial rotational reference as an alternative to the AP axis in unicompartmental knee arthroplasty. Methods We scanned the knees of 24 healthy Asian patients (45 knees) at a flexion angle of 908 using open MRI, then measured the angle between the AP axis and the medial wall of the notch. We determined whether the origins of the ACL and PCL were located lateral to the line on the medial wall of the notch and whether the mediolateral dimension of the bone cut surface of the medial tibial plateau was wide enough relative to the AP dimension to use the commercially available unicompartmental knee arthroplasty tibial components when the tibia was cut parallel to the medial wall of the notch.Results At 908 flexion the medial wall of the notch was externally rotated 0.18 ± 4.48 relative to the AP axis. In all knees, the ACL and PCL were located lateral to the line on the medial wall of the notch. The mediolateral dimension of the bone cut surface was wide enough to use the commercially available tibial components. Conclusions At 908 flexion the medial wall of the intercondylar notch is almost parallel to the AP axis of the tibia at and we believe a reasonable candidate for a rotational reference of tibial placement in unicompartmental knee arthroplasty. This landmark would need to be confirmed in other populations and in patients with osteoarthritis.

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Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

Lee,

Kim,

Kwon

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeAlthough the Dejour classification is the primary classification system for evaluating trochlear dysplasia, concerns have been raised about its reliability owing to its qualitative criteria and challenges associated with obtaining accurate radiographs. This study aimed to quantify trochlear dysplasia using three‐dimensional (3D) computed tomography (CT) reconstruction with novel parameters related to the transepicondylar axis (TEA).MethodsSixty patients were enrolled, including 20 with trochlear dysplasia and 40 healthy controls. The 3D CT model was generated using the Materialise Interactive Medical Image Control System software. The following six parameters were measured in eight consecutive planes at 15° intervals (planes 0–105): the distance from the TEA to the most cortical point of the lateral condyle (‘LP‐TEA’, where LP stands for lateral peak), medial condyle (‘MP‐TEA’, MP for medial peak) and deepest point of the trochlea (‘TG‐TEA’, TG for trochlear groove). The distances from the medial epicondyle (MEC) to the corresponding TEA points were measured (‘LP‐MEC’, ‘MP‐MEC’ and ‘TG‐MEC’).ResultsIn the dysplasia group, TG‐TEA (planes 0, 15 and 30) and MP‐MEC (planes 0, 15 and 30) were significantly greater than those in the control group (all p < 0.05 for planes of TG‐TEA and MP‐MEC). For type A dysplasia, LP‐MEC (plane 0) was greater than that in the control group. For type B dysplasia, the MP‐MEC (planes 0 and 15) and TG‐TEA (planes 0 and 15) were greater than those of the control group. For type D dysplasia, MP‐MEC (planes 0, 15 and 30) and TG‐TEA (planes 0 and 15) were elevated.ConclusionThe 3D CT reconstruction analysis established a reproducible method for quantifying osseous trochlear morphology. Patients with trochlear dysplasia had a shallow TG and narrow medial trochlear width at tracking angles of 0°–30°. This finding corroborates the clinical manifestations of recurrent patellar instability that occur during early flexion.Level of EvidenceLevel III.

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Knee functional flexion axis in osteoarthritic patients: comparison in vivo with transepicondylar axis using a navigation system

Abstract: FFA can be used as reference for implant positioning in axial plane also in pathologic knees, while for the frontal plane further investigations are required.

Cited by 32 publications

References 54 publications

Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

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