Measurement of the knee joint line in Turkish population

Gürbüz, Hülya; Çakar, Murat; Adaş, Müjdat; Tekin, Ali Çağrı; Bayraktar, Mehmet Kürşad; Esenyel, Cem Zeki

doi:10.3944/aott.2015.14.0050

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…FH may not be a precise landmark in locating femoral JL, which had been proved by several investigators recently [ 15 , 18 ]. In Chinese people, FH may not serve as a reliable landmark either ( R 2 = 0.1003).…”

Section: Discussionmentioning

confidence: 99%

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Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study

Fan

et al. 2018

J Orthop Surg Res

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BackgroundRestoring the normal joint line (JL) is an important goal to achieve in total knee arthroplasty (TKA). We intended to study the veracity of several landmarks used to level the normal JL in Chinese people.MethodsTwo hundred fifteen standard CT scans of knee joint were included to measure the distances from landmarks to distal JL (DJL) and posterior JL (PJL), along with femoral width (FW) in order to calculate the ratios. Landmarks included adductor tubercle (AT), medial epicondyle (ME), lateral epicondyle (LE), tibial tubercle (TT), fibular head (FH) and the inferior pole of the patella (IPP). Ratios were calculated between distances and FW (e.g. FHDJL/FW). Linear regression analysis and t test were used to determine the accuracy and the differences amongst sides of the leg, genders and races.ResultsThe average of IPPDJL/FW, TTDJL/FW, FHDJL/FW, LEDJL/FW, LEPJL/FW, MEDJL/FW, MEPJL/FW, ATDJL/FW and ATPJL/FW were 0.165, 0.295, 0.232, 0.297, 0.281, 0.327, 0.3PJL, 0.558 and 0.313, respectively. No significant difference had been found between the left and right leg. A gender difference was only found statistically on the ratio of IPP, and also, no linear correlation was observed only between IPP and FW. Most of the difference values lain in a 4-mm threshold for MEDJL (95.81%), LEDJL (94.88%), MEPJL (97.21%), LEPJL (94.88%), ATPJL (93.49%) and ATDJL (100%). Significant differences were observed amongst different races.ConclusionsAT, ME and LE can be used as reliable landmarks to locate the normal JL in Chinese population intraoperatively. It is meaningful to come up with a set of ratios to different races.

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Section: Discussionmentioning

confidence: 99%

“…With the benefits of ratios, studies showed a slight difference between different races [ 9 , 15 ]. And several studies have already proved the distinction between the Chinese population and other countries [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study

Fan

et al. 2018

J Orthop Surg Res

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“…Computed tomography (CT), magnetic resonance imaging (MRI) and plain radiographs can be used to determine the position of the JL, 10 , 15 and reports have shown no difference between CT, MRI and plain radiograph measurements. 10 , 16 , 17 In our study, we used plain radiographs for calculating the AR, since it is the most cost-effective and accessible option used in diagnosing knee diseases, preoperative planning of surgical procedures and evaluating postoperative results. 7 Several studies pointed out the requirement of calibrated preoperative radiographs to estimate the AR.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 3 , 6 , 8 , 9 Recently, the adductor tubercle has been presented as a new bony landmark and the most useful, in determining the articular level in revision knee arthroplasty cases. 7 , 10 …”

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confidence: 99%

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?

Boya

Arac

2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveIn our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level.MethodsData from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight-bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test.ResultsMost of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 ± 0.031 and Mean AR in Group 1: 0.502 ± 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined.ConclusionIn conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients.Level of evidenceLevel III, Diagnostic study.

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“…According to gender, ethnicity, and patient’s stature, the reported distances from bony landmarks to knee joint line have high variation [ 13 ]. Some authors have suggested that the ratio of the distance from bony landmarks to the joint line and the femoral transepicondylar width (FW), also called the “epicondylar ratio,” is more reliable than the distances from landmarks to joint line [ 8 , 9 , 14 ]; however, studies based on specific ethnic populations have found variations in the proposed ratios [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population

Tantavisut

Amarase

Ngarmukos

et al. 2022

Knee Surg & Relat Res

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Background During revision total knee arthroplasty (TKA), knee joint line restoration may be difficult due to bone loss or structural changes. Although bony landmarks are consistent and can be used as references, there are limited data in Asian patients. We studied the knee joint line related to bony landmarks of the knee in a Thai population. Materials and methods Magnetic resonance imaging (MRI) of 140 healthy knees of Thai patients (70 males, 70 females) were investigated. In all knees, a perpendicular line from knee joint line to the medial epicondyle (distance A) and the lateral epicondyle (distance B) in the coronal plane were measured. In the sagittal plane, a perpendicular line from the knee joint line to the fibular head (distance C), the tibial tubercle (distance D), and the inferior patellar pole (distance E) were measured. The femoral transepicondylar width (FW) was measured along the transepicondylar axis. The ratios of distances A, B, C, D, and E related to FW were evaluated (epicondylar ratio). Results The mean and standard deviation (SD) of distances A, B, C, D, E, and FW were 27.1 ± 2.7 mm, 21.7 ± 2.5 mm, 12.6 ± 3 mm, 21.3 ± 3.6 mm, 7.6 ± 4.8 mm, and 76.7 ± 3.99, respectively. There was wide variation of measured values, with statistically significant differences between genders in distances A, B, C, and FW. The mean and SD of epicondylar ratios A/FW, B/FW, C/FW, D/FW, and E/FW were 0.35 ± 0.02, 0.29 ± 0.02, 0.16 ± 0.05, 0.28 ± 0.04, and 0.09 ± 0.04, respectively. All epicondylar ratios demonstrated less variation than all measured distances, with statistical differences between genders in the A/FW and D/FW ratios. However, the B/FW ratio had the highest consistent mean value. In addition, it had narrower SD than the rest (0.29 ± 0.02; range, 0.22–0.33). Conclusions In Thai knees, the measured distances from bony landmarks to the knee joint line had higher variation than the epicondylar ratio. Among all studied epicondylar ratios, the ratio between lateral epicondyle to joint line distance (distance B)/FW demonstrated the narrowest range of mean and SD values; therefore, this could be the most reliable landmark for intraoperative knee joint line verification by multiplying the FW of the patient by 0.29 to get distance B in that patient.

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Measurement of the knee joint line in Turkish population

Cited by 5 publications

References 14 publications

Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study

Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?

Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population

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