Relevance of the Tibial Slope on Functional Outcomes in ACL-Deficient and ACL Intact Fixed-Bearing Medial Unicompartmental Knee Arthroplasty

Plancher, Kevin D.; Shanmugam, Jaya Prasad; Brite, Jasmine E.; Briggs, Karen K.; Petterson, Stephanie C.

doi:10.1016/j.arth.2021.04.041

Cited by 18 publications

(21 citation statements)

References 36 publications

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“…It was worth mentioning that this study is the first to quantify the wear of the tibia pattern on the lateral radiograph to predict ACLD using the Asian population. PTS-It has been reported in the literature that there was a correlation between PTS and ACL damage [ 19 , 20 , 33 ]. The larger the PTS, the more easily the ACL was damaged.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous literature, there have been several radiographic signs related to the status of ACL, including the tibial wear pattern on lateral radiographs [ 15 , 16 ], coronal tibiofemoral subluxation (CTFS) on anterior–posterior (AP) radiographs [ 17 , 18 ], posterior tibial slope (PTS) on lateral radiographs [ 19 , 20 ], and so on. However, the diagnostic accuracy of those radiographic signs varied in different pieces of literature, and related literature lacked the calculation of the cut-off value of those radiographic signs.…”

Section: Introductionmentioning

confidence: 99%

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A radiographic model predicting the status of the anterior cruciate ligament in varus knee with osteoarthritis

Liu

Huang

et al. 2022

BMC Musculoskelet Disord

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Purpose The study aims to investigate the accuracy of different radiographic signs for predicting functional deficiency of anterior cruciate ligament (ACL) and test whether the prediction model constructed by integrating multiple radiographic signs can improve the predictive ability. Methods A total number of 122 patients from January 1, 2018, to September 1, 2021, were enrolled in this study. Among them, 96 patients were classified as the ACL-functional (ACLF) group, while 26 patients as the ACL-deficient (ACLD) group after the assessment of magnetic resonance imaging (MRI) and the Lachman’s test. Radiographic measurements, including the maximum wear point of the proximal tibia% (MWPPT%), tibial spine sign (TSS), coronal tibiofemoral subluxation (CTFS), hip–knee–ankle angle (HKA), mechanical proximal tibial angle (mPTA), mechanical lateral distal femoral angle (mLDFA) and posterior tibial slope (PTS) were measured using X-rays and compared between ACLF and ACLD group using univariate analysis. Significant variables (p < 0.05) in univariate analysis were further analyzed using multiple logistic regression analysis and a logistic regression model was also constructed by multivariable regression with generalized estimating models. Receiver-operating-characteristic (ROC) curve and area under the curve (AUC) were used to determine the cut-off value and the diagnostic accuracy of radiographic measurements and the logistic regression model. Results MWPPT% (odds ratio (OR) = 1.383, 95% confidence interval (CI) = 1.193–1.603, p < 0.001), HKA (OR = 1.326, 95%CI = 1.051–1.673, p = 0.017) and PTS (OR = 1.981, 95%CI = 1.207–3.253, p = 0.007) were shown as predictive indicators of ACLD, while age, sex, side, TSS, CTFS, mPTA and mLDFA were not. A predictive model (risk score = -27.147 + [0.342*MWPPT%] + [0.282*HKA] + [0.684*PTS]) of ACLD using the three significant imaging indicators was constructed through multiple logistic regression analysis. The cut-off values of MWPPT%, HKA, PTS and the predictive model were 52.4% (sensitivity:92.3%; specificity:83.3%), 8.5° (sensitivity: 61.5%; specificity: 77.1%), 9.6° (sensitivity: 69.2%; specificity: 78.2%) and 0.1 (sensitivity: 96.2%; specificity: 79.2%) with the AUC (95%CI) values of 0.906 (0.829–0.983), 0.703 (0.574–0.832), 0.740 (0.621–0.860) and 0.949 (0.912–0.986) in the ROC curve. Conclusion MWPPT% (> 52.4%), PTS (> 9.6°), and HKA (> 8.5°) were found to be predictive factors for ACLD, and MWPPT% had the highest sensitivity of the three factors. Therefore, MWPPT% can be used as a screening tool, while the model can be used as a diagnostic tool.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A radiographic model predicting the status of the anterior cruciate ligament in varus knee with osteoarthritis

Liu

Huang

et al. 2022

BMC Musculoskelet Disord

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“…This angular error on the MRI was estimated to be 1.0° on average and less than 2.5° and is considered as negligible in clinical practice because it would be virtually impossible to manually adjust the extramedullary tibial cutting guide for less than single-degree precision. A small decline in the PTS may keep the bone stock in the proximal tibial and reduce the risk of increased postoperative stress on the ACL [16,20].…”

Section: Discussionmentioning

confidence: 99%

“…The posterior tibial slope (PTS) of the medial tibial plateau (MTP), de ned as the posterior inclination of the plateau relative to the tibial bone axis, is considered an important anatomical feature that in uences cruciate ligament function and sagittal plane stability of the knee [15,16,17,18,19] and wide individual variations of up to 14° have been reported in the PTS for both normal and arthritic knees [20,21,22].…”

Section: Introductionmentioning

confidence: 99%

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A Direct Referencing Method of the Tibial Plateau for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty

Akagi

Aya²,

Mori

et al. 2022

Preprint

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Purpose There is no consensus on intraoperative references for the posterior tibial slope (PTS) in medial unicompartmental knee arthroplasty (UKA). An arthroscopic hook probe placed on the medial second quarter of the medial tibial plateau (MTP) in an anteroposterior direction may be used as a direct anatomical reference for the PTS. The purpose of this study is to investigate availability and accuracy of this method. Methods Marginal osteophyte formation and subchondral depression of the MTP, and angles between the bony MTP and the cartilage MTP were retrospectively evaluated using preoperative sagittal MRI of 73 knees undergoing medial UKA. In another 36 knees, intraoperative lateral knee radiographs with the probe placed on the MTP were prospectively taken in addition to the preoperative MRI. Then, angles between the bony MTP and the probe axis and angles between the preoperative bony MTP and the postoperative implant MTP were measured. Results Among 73 knees, one knee with Grade 4 osteoarthritis had a posterior osteophyte higher than the most prominent point of the cartilage MTP. No subchondral depression affected the direct reference of the MTP. Mean angle between the bony MTP and the cartilage MTP was − 0.8°±0.7° (-2.6°-1.0°, n = 72), excluding the one knee with “high” osteophyte. Mean angle between the bony MTP and the probe axis on the intraoperative radiograph was − 0.6°±0.4° (-1.7-0.0, n = 36). Mean angle between the pre- and the postoperative MTP was − 0.5°±1.5° (-2.9°-1.8°). Root mean square (RMS) error of these two PTS angles was 1.6° with this method. Conclusion Cartilage remnants, osteophyte formation and subchondral bone depression does not affect the direct referencing method in almost all knees for which medial UKA is indicated. When the posterior “high” osteophyte of the MTP is noted on preoperative radiograph, preoperative MRI or CT scan is recommended to confirm no “high” osteophyte on the medial second quarter. Accuracy of this method seems equal to that of the robotic-assisted surgery (the RMS error in previous reports, 1.6°-1.9°).

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Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis

Plancher,

Briggs,

Commaroto

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA).MethodsA total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2‐year postoperative veterans RAND 12 item health survey (VR‐12) mental component score (MCS). VR‐12 MCS was the primary outcome measure. Secondary measures included VR‐12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow‐up.ResultsThe median VR‐12 MCS improved from 50.5 [interquartile range (IQR): 43.7−56.8] to 55.0 [IQR: 52.3−57.0] (p < 0.001) at a mean follow‐up of 9.5 ± 4 years (range 2−19 years) following UKA. Preoperative VR‐12 MCS was significantly correlated with patients postoperative VR‐12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty‐three (39%) patients improved from low VR‐12 MCS (<50) to normal VR‐12 MCS (≥50). One hundred forty‐two (87%) achieved a normal VR‐12 MCS score (≥50) postoperatively.ConclusionAt a mean of 10‐year follow‐up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living.Level of EvidenceLevel III retrospective cohort study.

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Relevance of the Tibial Slope on Functional Outcomes in ACL-Deficient and ACL Intact Fixed-Bearing Medial Unicompartmental Knee Arthroplasty

Cited by 18 publications

References 36 publications

A radiographic model predicting the status of the anterior cruciate ligament in varus knee with osteoarthritis

A radiographic model predicting the status of the anterior cruciate ligament in varus knee with osteoarthritis

A Direct Referencing Method of the Tibial Plateau for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty

Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis

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