The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

Abstract

Rotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterior (AP) axis of the tibial tray was marked. The angles between the TEA and these lines were calculated, and the statistical differences were analyzed. The angle between the TEA and the Akagi line and between the TEA and the line connecting the medial third of the tibial tubercle with the midpoint of the PCL were 96.90 ± 5.57 and 107.31 ± 5.95 degrees, respectively. The angles between the TEA and the AP axis of the symmetrical and the asymmetrical design tibial trays were 94.01 ± 4.21 and 96.65 ± 4.70 degrees, respectively. Except for the Akagi line and AP axis of the asymmetrical tibial tray, statistical differences were found between all lines (p < 0.05). The PLCL technique is principally suitable for Chinese patients requiring TKA when using the tibial component referred to in this study, although it may result in slight external rotation.

The clinical outcome of minimally invasive popliteal tendon recess procedure is comparable to arthroscopic popliteal tendon reconstruction in patients with type A posterolateral rotational instability

“…Postoperative rehabilitation played a significant role in the clinical outcome of PCL/PLC surgery [8, 18, 33, 34]. In the present study, the protocol varied in acute and chronic settings.…”

Moderate External Rotation of Tibial Component Generates More Natural Kinematics Than Internal Rotation After Total Knee Arthroplasty

“…The influence of tibial malalignment on kinematics might be more specific with more simulations of different alignments. The value of malrotation was set according to a previous work in which the degree of tibial malrotation was measured referencing the Akagi line, medial 1/3 tibia tubercle, or the posterolateral corner-locked (PLCL) technique in the normal Chinese population ( Fang et al, 2020 ). According to a retrospective cohort study with 3,048 knees, 2–5° external rotation of the tibial component accounted for 2,490 knees, which was shown as the main rotational alignment in clinical practice ( Kim et al, 2014 ).…”

Femoral matched tibia component rotation has little effect on the tibial torsion after total knee arthroplasty

“…Various surgical techniques are used to determine the rotational alignment of the tibial component during total knee arthroplasty (TKA) [1, 3, 7, 10, 11, 16, 24]. Possible anatomical landmarks for determining rotational alignment are tibial tuberosity, anterior tibia crest, tibial eminence, anterior or posterior tibial condylar line, patellar tendon, and second metatarsal bone.…”