Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs

Maderbacher, Günther; Schaumburger, Jens; Baier, Christel; Zeman, Florian; Springorum, Hans-Robert; Dornia, Christian; Grifka, Joachim; Keshmiri, Armin

doi:10.1007/s00167-014-3327-4

Cited by 44 publications

(39 citation statements)

References 19 publications

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“…Rotation of the lower limbs in long-leg radiographs was calculated using the equation 12 : "Rotation [degrees] ¼ À 14.20 À 0.17 Â visible part of the fibula (%) þ 0.35 Â overlapped part of the fibular tip (%) þ 0.31 Â distance between the fibular tip and the lateral fibular cortex (%)." In accordance with the above mentioned study, 12 the proximal fibular width, the distance between the lateral fibular cortex and the lateral tibial cortex (visible part of the fibula), the distance between the tip of the fibula and the lateral tibial cortex (overlapped part of the fibular tip), and the distance between the lateral fibular cortex and the fibular tip were measured.…”

Section: Assessment Of Lower Limb Rotation Angular Parameters and Rmentioning

confidence: 99%

“…10,11 As present, malrotation of the lower limb could not be assessed in long-leg radiographs until recently, a calculation method was introduced which allows to determine rotation of the lower limb in radiographs by measuring the extent of overlap of the proximal fibula. 12 It was hypothesized that: (1) long-leg radiographs regularly are not conducted in desired exact AP rotation of the lower limb and (2) resulting in significant changes of measured alignment parameters (AMA, mLPFA, mLDFA, mLDTA, mMPTA, and mechanical tibio-femoral angle).…”

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Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors

et al. 2019

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Weight-bearing long-leg radiographs are commonly used in orthopaedic surgery. Measured parameters, however, change when radiographs are conducted in different rotational positions of the leg. It was hypothesized that rotational errors are regularly present in long-leg radiographs resulting in wrong measurements. In 100 consecutive long-leg radiographs conducted according to the method of Paley, rotation was assessed by fibular overlap. Angular parameters in radiographs (mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle between the anatomical and mechanical femoral axis (AMA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), and the mechanical femoral and tibial axis (mFA–mTA) were measured and deviations related to malrotation calculated. An average internal rotation of 8 degrees was found in lower limbs showing a range between 29 degrees of internal and 22 degrees of external rotation. As a result, mean differences before and after rotational correction for measured parameters (mLPFA, mLDFA, AMA, mMPTA, mLDTA, mFA–mTA) ranged between 0.4 and 1.7 degrees (−2.1; 5.6 95% confidence interval [CI]). In conclusion, malrotation of lower limbs is regularly present in long-leg radiographs. As all measured parameters are influenced by malrotation, correct lower limb rotation needs to be verified.

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Section: Assessment Of Lower Limb Rotation Angular Parameters and Rmentioning

confidence: 99%

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confidence: 99%

Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors

et al. 2019

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“…In contrast to many other studies in which the transepicondylar line was used, in the present experimental setup, the PCL was chosen to reference femoral rotation since inaccuracies were reported to assess the medial and lateral epicondyles. 22 Furthermore, the Akagi et al's line 13,23 was used to determine tibial AP axes. Although all knees showed a normal anatomy, it is not always easy to assess during surgery.…”

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confidence: 99%

Impact of Axial Component Alignment in Total Knee Arthroplasty on Lower Limb Rotational Alignment: An In Vitro Study

et al. 2016

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Correct rotational implant alignment is associated with increased postoperative function and implant survival in total knee arthroplasty (TKA). Due to conformity between tibial and femoral implants, particularly in full extension, we assumed a mutual interference of femoral and tibial component rotations. We, therefore, hypothesized that different rotational alignments of the tibial or femoral components change the rotational postures between the tibia and femur after TKA. In 10 healthy knees of whole body cadavers, TKA was performed. Both femoral and tibial components were implanted in different internal (6 degrees) and external (3 and 6 degrees) rotational alignments. Consequential osseous rotational changes between the tibia and the femur were measured in full extension using a commercial computer navigation device. External rotation of the femoral component resulted in significant external rotation of the tibia, while external rotation of the tibial component caused a significant internal rotation of the tibia. The opposite applied to femoral and tibial component internal rotations. Therefore, largest changes of the osseous tibiofemoral rotational postures were found by the combination of 6 degrees femoral component internal and 6 degrees tibial component external rotations (mean 11.2 degrees, standard deviation 5.0, < 0.001), as both cause tibial internal rotation. In conclusion, the present results suggest that axial component alignment significantly affects lower limb rotational alignment. However, its clinical impact on forefoot progression, Q-angle, the patella, collateral, and cruciate ligaments, and surrounding soft tissues has to be clarified in further clinical and biomechanical studies.

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“…Accordingly, the angle between the cranial tangent of the clavicle and the tangent to its articular surface was identified. Analysis was performed in accordance to the description of measuring the lateral distal femur angle (ldfa) [ 11 – 13 ].…”

Section: Methodsmentioning

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Analysis of the bony geometry of the acromio-clavicular joint

et al. 2018

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BackgroundThe primary goal of this study was to analyse the anatomic configuration of the acromio-clavicular joint in a healthy population to be able to develop a classification in a second step. On the basis of the primary findings a secondary goal was to find potential clinical indications in refer to AC-joint dislocation and lateral clavicle fractures.MethodsThe upper thoracic aperture including both shoulder joints as well as both sterno-clavicular joints was retrospectively reformatted in a bone kernel in axial orientation with 0.6 mm slice thickness out of existing multiple trauma or post mortem computed tomography (CT) scans. The DICOM data was converted into the STL file format using a three dimensional (3D) reconstruction software (Smartbrush, Brainlab, Feldkirchen, Germany). The data analysis was performed using a 3D—Computer Aided Detection (CAD) Software (BioCAD, Technical University Munich, Germany). For the analysis, the angle between the cranial surface of the acromion and the tangent to its articular surface was evaluated. Accordingly, the angle between the cranial surface of the clavicle and the tangent to its articular surface was assessed.ResultsOverall CT-datasets of 80 healthy patients (40 males, 40 females, mean age 45 ± 8 years) were enrolled and evaluated regarding the configuration of the AC-joint. In this context, three statistically significant (p < 0.001) different configurations of the AC-joint in terms of overhanging acromion, neutral type, overhanging clavicle were identified. The “overhanging acromion” type of AC-joint configuration turned out to be the most common type (46.2%) followed by the “neutral type” (38.4%) and finally the “overhanging clavicle type” (15.4%).ConclusionsWe assume that the shown differences of the AC joint congruency might play an important role in the development of different shoulder injuries resulting from the similar trauma mechanism. However, the proof of these assumptions will be the focus of future studies.

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Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs

Abstract: Diagnostic study, Level II.

Cited by 44 publications

References 19 publications

Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors

Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors

Impact of Axial Component Alignment in Total Knee Arthroplasty on Lower Limb Rotational Alignment: An In Vitro Study

Analysis of the bony geometry of the acromio-clavicular joint

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