Abstract:Purpose: to compare the anterior tibial surface curvature, the Akagi's line and the medial third of the tibial tubercle in order to assess which is the most reliable landmark for correct tibial component rotational positioning in total knee arthroplasty. Methods: three independent investigators reviewed 124 knee MRI scans. The most suitable tibial baseplate tracing for the Nexgen Total Knee System (Zimmer, Warsaw, USA) was superimposed on the scan matching the anterior tibial cortex with the anterior aspect of… Show more
“…To determine the rotational alignment of the tibial component in TKA, several anatomical landmarks on the proximal tibia have been proposed [17–27]. Many studies have shown that the tibial tuberosity is a reliable landmark [24, 35–37].…”
Section: Discussionmentioning
confidence: 99%
“…1e) [27]; and (5) the AP axis of the tibial prosthesis, using a tibial prosthesis template (LPS-Flex; Zimmer, Warsaw, IN, USA), along the ATCC (Fig. 1f) [17]. Internal rotation was shown as a negative value, while external rotation was shown as a positive value.Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Therefore, many anatomical landmarks on the proximal tibia have been used to determine tibial rotational alignment in TKA, including the medial one-third of the tibial tuberosity, medial border of the tibial tuberosity, apex of the tibial tuberosity, midsulcus line, and medial border of the patellar tendon [17–27]. However, these landmarks are difficult to identify after cutting the tibia and vary greatly among patients [20, 21, 28].…”
Section: Introductionmentioning
confidence: 99%
“…Recently, Baldini et al [17] proposed that the anterior tibial curved cortex (ATCC) represents a reproducible and reliable landmark for tibial rotational alignment. The approach using the ATCC as a landmark proceeds as follows: after cutting the proximal tibia, the anterior surface of the tibial baseplate is matched with the ATCC of the proximal tibia.…”
BackgroundRotational alignment of the tibial component is important for long-term success of total knee arthroplasty (TKA). This study aimed to compare five axes in normal and osteoarthritic (OA) knees to determine a reliable landmark for tibial rotational alignment in TKA.MethodsOne hundred twenty patients with OA knees and 40 with normal knees were included. The angle between a line perpendicular to the surgical transepicondylar axis and each of five axes were measured on preoperative computed tomography. The five axes were as follows: a line from the center of the posterior cruciate ligament (PCL) to the medial border of the patellar tendon (PCL-PT), medial border of the tibial tuberosity (PCL-TT1), medial one-third of the tibial tuberosity (PCL-TT2), and apex of the tibial tuberosity (PCL-TT3), as well as the anteroposterior axis of the tibial prosthesis along the anterior tibial curved cortex (ATCC).ResultsFor all five axes tested, the mean angles were smaller in OA knees than in normal knees. In normal knees, the angle of the ATCC axis had the smallest mean value and narrowest range (1.6° ± 2.8°; range, −1.7°–7.7°). In OA knees, the mean angle of the ATCC axis (0.8° ± 2.7°; range, −7.9°–9.2°) was larger than that of the PCL-TT1 axis (0.3° ± 5.5°; range, −19.7°–10.6°) (P = 0.461), while the angle of the ATCC axis had the smallest SD and narrowest range.ConclusionThe ATCC was found to be the most reliable and useful anatomical landmark for tibial rotational alignment in TKA.
“…To determine the rotational alignment of the tibial component in TKA, several anatomical landmarks on the proximal tibia have been proposed [17–27]. Many studies have shown that the tibial tuberosity is a reliable landmark [24, 35–37].…”
Section: Discussionmentioning
confidence: 99%
“…1e) [27]; and (5) the AP axis of the tibial prosthesis, using a tibial prosthesis template (LPS-Flex; Zimmer, Warsaw, IN, USA), along the ATCC (Fig. 1f) [17]. Internal rotation was shown as a negative value, while external rotation was shown as a positive value.Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Therefore, many anatomical landmarks on the proximal tibia have been used to determine tibial rotational alignment in TKA, including the medial one-third of the tibial tuberosity, medial border of the tibial tuberosity, apex of the tibial tuberosity, midsulcus line, and medial border of the patellar tendon [17–27]. However, these landmarks are difficult to identify after cutting the tibia and vary greatly among patients [20, 21, 28].…”
Section: Introductionmentioning
confidence: 99%
“…Recently, Baldini et al [17] proposed that the anterior tibial curved cortex (ATCC) represents a reproducible and reliable landmark for tibial rotational alignment. The approach using the ATCC as a landmark proceeds as follows: after cutting the proximal tibia, the anterior surface of the tibial baseplate is matched with the ATCC of the proximal tibia.…”
BackgroundRotational alignment of the tibial component is important for long-term success of total knee arthroplasty (TKA). This study aimed to compare five axes in normal and osteoarthritic (OA) knees to determine a reliable landmark for tibial rotational alignment in TKA.MethodsOne hundred twenty patients with OA knees and 40 with normal knees were included. The angle between a line perpendicular to the surgical transepicondylar axis and each of five axes were measured on preoperative computed tomography. The five axes were as follows: a line from the center of the posterior cruciate ligament (PCL) to the medial border of the patellar tendon (PCL-PT), medial border of the tibial tuberosity (PCL-TT1), medial one-third of the tibial tuberosity (PCL-TT2), and apex of the tibial tuberosity (PCL-TT3), as well as the anteroposterior axis of the tibial prosthesis along the anterior tibial curved cortex (ATCC).ResultsFor all five axes tested, the mean angles were smaller in OA knees than in normal knees. In normal knees, the angle of the ATCC axis had the smallest mean value and narrowest range (1.6° ± 2.8°; range, −1.7°–7.7°). In OA knees, the mean angle of the ATCC axis (0.8° ± 2.7°; range, −7.9°–9.2°) was larger than that of the PCL-TT1 axis (0.3° ± 5.5°; range, −19.7°–10.6°) (P = 0.461), while the angle of the ATCC axis had the smallest SD and narrowest range.ConclusionThe ATCC was found to be the most reliable and useful anatomical landmark for tibial rotational alignment in TKA.
“…Cemented PS femoral components from each group were aligned rotationally according to the patient's surgical transepicondylar. The rotational alignment of all cemented symmetric tibial components was set matching the contour of the tibial anterior cortex, following author's previously published surgical technique [17]. All patellae were replaced using a “free hand technique” without cutting guides, and tracking of the patella was checked using the “no thumb technique” [18].…”
BackgroundTotal knee arthroplasty (TKA) designs continue to be modified to optimize patient's outcome. This study was designed to compare clinical and radiological results of classic worldwide used TKA posterior-stabilized (PS) design to those of its recent evolution.MethodsA consecutive group of 100 patients undergoing TKA using a classic cemented fixed-bearing PS TKA system was matched by age, gender, body max index to 100 patients having the newer cemented fixed-bearing PS design, both by the same manufacturer. Patients were assessed preoperatively, at 12 months and at 24 months minimum follow-up (range, 24-46) in a standard prospective fashion. The outcome assessments used were the Oxford Knee Score, the Knee Society Score, range of motion, and a satisfaction survey. A 2-sample t test comparing the 2 groups was performed.ResultsNo patients were lost at follow-up. At 2-year follow-up, differences in clinical and radiological Knee Society Score (P = .09), Oxford Score (P = .08), and overall satisfaction rate did not reach statistical significance. Implant group 2 showed a statistically significant decrease in postoperative anterior knee pain (P = .006). At final follow-up, 16% of group 1 knees achieved > 130° flexion compared with 37% in group 2 (P = .0009). There were 2 revisions for any reason in group 1 and none in group 2.ConclusionsDesign modifications applied to the newer TKA system allowed greater flexion and lower patellofemoral complications but did not appear to achieve better overall clinical scores.
The tip of the tibial tubercle (TTT) is used to assess tibial baseplate rotation in total knee arthroplasty (TKA); however, it can be difficult to palpate and visualize intraoperatively. Several more easily accessible soft-tissue structures have been proposed as intraoperative assessments, including the patellar tendon's medial border (MBPT) and the junction of the medial third of the patellar tendon (mt-PT). No studies have described the relationship between the TTT and these proposed landmarks. The aims of the study were to (1) determine the relationship of the soft-tissue landmarks to the TTT and (2) identify any sex differences in these measures. Measurements of the position of these soft-tissue landmarks relative to the TTT were made on 56 cadaveric knees (28 female) by two observers at the level of the standard tibial cut (10 mm distal to the lateral tibial plateau). The results obtained were compared by sex and side.On average, 50.7% (SD 6.79, range 33.1%-63.1%) of the patellar tendon footprint was medial to the TTT. There were no significant differences between the sexes or left and right lower limbs. However, there was large variability in the position of all the soft-tissue landmarks relative to the TTT. The results indicate that, on average, the patellar tendon footprint is evenly spread around the TTT. However, there is a large variability in the anatomical relationship between the soft-tissue landmarks and the TTT. Caution is advised if relying on these structures intraoperatively.
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