The accuracy of tibial intramedullary alignment devices in total knee arthroplasty

Tibialis Anterior Tendon: A Reliable Anatomical Landmark Indicating the Ankle Centre. Potential Utility in Extra-Medullary Alignment During Total Knee Replacement

“…These include the second metatarsal, extensor hallucis longus tendon, intermalleolar point etc (15)(16)(17)(18)(19)(20). However these landmarks are variable and difficult to precisely isolate during surgery.…”

“…This suboptimal positioning is despite improvements in surgical techniques and instrumentation (13,14). Studies have described many anatomical landmarks for aligning extramedullary alignment guides but there is wide variation in the description of these landmarks among papers (15)(16)(17)(18)(19). We attempt to prove that the tibialis anterior tendon has a stable relation with the ankle centre and can be utilized in extramedullary alignment technique.…”

Reliable and reproducible technique to mark center of ankle in total knee arthroplasty

“…Failure rate rises when the tibial implants are placed in varus or valgus 1 In valgus deformities, 7 severe tibial bowing 8 and residual deformity after osteotomy, intramedullary systems do not ensure correct tibial cuts, justifying the use of extramedullary guides. Furthermore, extramedullary guides avoid the potential complications of intra-medullary guide use, including fat embolization and hypoxia and intra-operative fracture.…”

Accuracy of Proximal Tibial Bone Cut Using Anterior Border of Tibia as Bony Landmark in Total Knee Arthroplasty

“…Several references for aligning extramedullary alignment guides have been reported [16][17][18][19][20]; however, these landmarks have varied widely among papers. It would be ideal to identify a stable landmark so as to allow surgeons to most accurately realize the tibial mechanical axis.…”

“…The position of the distal end is defined subjectively, which can cause incorrect alignment because it is difficult to find the center of the ankle joint, especially in obese patients with an excess of soft tissue and in osteoarthritis patients with abnormal ankle anatomy [13]. The optimal placement within 3°was reportedly achieved in only 70% to 80% of patients when using extramedullary alignment guides, despite improvements in surgical techniques and jigs [14,15].Several references for aligning extramedullary alignment guides have been reported [16][17][18][19][20]; however, these landmarks have varied widely among papers. It would be ideal to identify a stable landmark so as to allow surgeons to most accurately realize the tibial mechanical axis.…”