Variability of the Posterior Tibial Slope in Saudis: A Radiographic Study

Aljuhani, Wazzan S; Qasim, Salman S; Alsalman, Mohammed

doi:10.7759/cureus.10699

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…The posterior slope value was set up to replicate the natural slope up to 9°. Though 9° is slightly higher than what has been recommended, as noted by de Boer et al [11], this is in line with the patient population of this study [11, 36, 51] and occurred in only 15 patients (37.5%) in the AFIP group with an extremely high preoperative posterior tibial slope of [68–80°]. After the final verification of the planning, the cuts were performed using the robotic arm to complete the distal femoral cut first, the anterior and posterior cuts, and then the tibial cut.…”

Section: Methodssupporting

confidence: 92%

An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique

Parratte

Overschelde

Bandi

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeAn anatomo‐functional implant positioning (AFIP) technique in total knee arthroplasty (TKA) could restore physiological ligament balance (symmetric gap in extension, asymmetric gap in flexion). The purposes were to compare (1) ligament balancing in extension and flexion after TKA in the AFIP group, (2) TKA alignment, implant positioning and patellar tracking between AFIP and adjusted mechanical alignment (aMA) techniques, (3) clinical outcomes between both groups at 12 months. MethodsAll robotic‐assisted TKA with an AFIP technique were included (n = 40). Exclusion criteria were genu valgum (HKA angle > 183°), extra‐articular deformity more than 10°, and patellar maltracking (high‐grade J‐sign). One control patient with a TKA implanted by an aMA technique was matched for each case, based on age, body mass index, sex, and knee alignment. Ligament balancing (medial and lateral gaps in millimeters) in full extension and at 90° of flexion after TKA in the AFIP group was assessed with the robotic system. TKA alignment (HKA angle), implants positioning (femoral and tibial coronal axis, tibial slope, joint‐line orientation), patellar tracking (patellar tilt and translation) and the Knee Society Score (KSS) at 6 and 12 months were compared between both groups. The ligament balancing was compared using a t test for paired samples in the AFIP group. The radiographic measurements and KSS scores were compared between groups using a t test for independent samples. ResultsIn the AFIP group, there was no significant difference between the medial and lateral gap laxity in extension (NS). A significant opening of the lateral gap was observed in flexion compared to extension (mean: + 2.9 mm; p < 0.0001). The mean postoperative HKA angle was comparable between both groups (177.3° ± 2.1 in the AFIP group vs 176.8° ± 3.2; NS). In the AFIP group, the femoral anatomy was restored (90.9° ± 1.6) and the tibial varus was partially corrected (87.4° ± 1.8). The improvement of Knee and Function KSS at 6 months was better in the AFIP group (59.3 ± 11.9 and 51.7 ± 20, respectively, versus 49.3 ± 9.7 and 20.8 ± 13; p < 0.001). ConclusionThe AFIP concept allowed the restoration of the native knee alignment and a natural functional ligament pattern. With a more physiological target for ligament balancing, the AFIP technique had equivalent clinical outcomes at 12 months compared to aMA, with a faster recovery. Level of evidenceIII retrospective therapeutic case control series.

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Section: Methodssupporting

confidence: 92%

An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique

Parratte

Overschelde

Bandi

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…There was no correlation between age, gender and PTS angles. 18 The values showed the difference of PTS in Saudi people comparing to deferent communities. Therefore, more comprehensive studies to search for the reported difference and calculation of actual PTS number of the Saudi community are needed.…”

Section: Discussionmentioning

confidence: 94%

Posterior tibial slope measurement among Saudi population

Alsowaigh¹,

Arafah²,

Alharbi,³

et al. 2021

MOJOR

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To measure the posterior slope of the tibia among the healthy Saudi population using Magnetic Resonance Imaging (MRI). A retrospective study review of 151 knee MRIs at King Khaled University Hospital, Riyadh, Saudi Arabia. All patients with no previous surgical intervention to their knees and did not suffer any bone injury around the knee were included. Three different orthopedic physicians (two senior residents, one orthopedic fellow) measured the posterior tibial slope (PTS) angle for all patients, and their average was taken for all readings using a sagittal T2 MRI cut. Patients with a history of previous surgical intervention to the knee joint, trauma involving distal femur or proximal tibia, osteoarthritis and inflammatory arthritis, and congenital deformities were excluded from the study. The mean age of patients was 28.15 in a range of 15-50 years. The posterior tibial slope mean and the median and the mode were 8.76, 8.73, 7.53, respectively. In addition, the mean angle (degree) in females was 9.69±4.02 and 8.76±4.15 in males. The Maximum and the minimum posterior slope angle calculated in these patients were respectively 19.73 and 0.3 degrees. Our findings are that the mean posterior tibia slope among the Saudi population is 8.76˚. The results showed the difference of PTS in Saudi people comparing to deferent communities. The association between the numbers of the posterior tibial slope with gender was tested and no significant correlation. In this study, we did not calculate weight and height in the cases as independent factors. Because of that, upcoming studies might consider these factors.

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“…This study can serve as a reference when performing measurements of knee-related radiographic parameters. PTS, which directly re ects the bony morphology of the tibia articular surface, is known to exhibit signi cant inter-individual variability [12][13][14][15][16][17]. This variability in PTS is reported to have a substantial impact on joint biomechanics [23,[25][26][27]; on the other hand, it may also in uence the measurement accuracy of related radiographic parameters.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, these characteristics become more evident in the proximal tibial surface. The morphology of the proximal tibial surface differs between the medial and lateral compartments of the knee, with noteworthy inter-individual differences [12][13][14][15][16][17]. Furthermore, as it directly mirrors the articular surface, its variability potentially affects the measurement outcomes of radiographic variables that include the joint line.…”

mentioning

confidence: 99%

The Posterior Tibial Slope Affects the Measurement Reliability Regarding the Radiographic Parameter of the Knee

Lee,

Yoo,

Kwak

et al. 2023

Preprint

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Background Posterior tibial slope (PTS) exhibits considerable variability among individuals and is anticipated to influence the accuracy of radiographic measurements related to the knee. Despite this potential impact, there is a lack of prior research investigating how PTS affects the accuracy of these measurements. Therefore, this study aimed to investigate the effect of PTS on the measurement reliability regarding the radiographic parameter of the knee. Methods The medical records of patients who took full-length anteroposterior radiographs of the lower limb between January 2020 and June 2022 were evaluated retrospectively. Radiographic parameters related to the knee joint characteristics such as osteoarthritis grade, hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle (MPTA), lateral distal femoral angle, joint-line convergence angle (JLCA), and PTS were measured. Subjects were classified into 3 groups according to PTS (group A, PTS < 4°; group B, PTS ≥ 4° and < 8°; group C, PTS ≥ 8°), and the measurement reliability for the radiographic variables mentioned above was compared between groups. The intra- and inter-observer agreements were assessed using the kappa coefficients, intra-class correlation coefficients (ICC), and Bland-Altman plots. Results A total of 175 limbs (86 patients) were included in this study. As the intra- and inter-observer reliability for PTS ranged over 0.9, grouping was performed based on the average of the measured PTSs. In the 3-group comparison of measurement reliability for radiographic parameters, the inter-observer reliability of the MPTA and JLCA decreased as the PTS increased (ICCs for MPTA in Groups A, B, and C: 0.889, 0.796, and 0.790, respectively; ICCs for JLCA in Groups A, B and C: 0.916, 0.859, and 0.843, respectively), whereas there were no remarkable differences in other variables. Similar trends were observed in the comparisons of intra-observer reliability. Additional Bland-Altman plots also showed consistent results. Conclusion The larger the PTS, the lower the measurement reliability regarding the radiographic parameters of the knee that includes the joint line, such as MPTA and JLCA. Since accurate identification of the joint line of the knee is occasionally challenging in patients with a relatively large PTS, care should be exercised when measuring these radiographic parameters.

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Variability of the Posterior Tibial Slope in Saudis: A Radiographic Study

Cited by 9 publications

References 25 publications

An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique

An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique

Posterior tibial slope measurement among Saudi population

The Posterior Tibial Slope Affects the Measurement Reliability Regarding the Radiographic Parameter of the Knee

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