An Anteroposterior Axis of the Tibia for Total Knee Arthroplasty

Akagi, Masao; Oh, Masamichi; Nonaka, Tohgo; Tsujimoto, Harutoshi; Asano, Tsuyoshi; Hamanishi, Chiaki

doi:10.1097/00003086-200403000-00030

Cited by 384 publications

(332 citation statements)

References 18 publications

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“…Moreover, the SEA is a functional flexion-extension axis and considered an anatomic basis of the coronal plane of the knee reference [8,9,14,20,29], although the reliability of the SEA measurement has not been proven [3,5]. We believe the AP axis of the tibia described by Akagi et al [1] is the appropriate rotational reference of the tibia. Theoretically, there is no rotational mismatch between the femoral and tibial components in extension when surgeons use the AP axis as the rotational reference of the tibia.…”

Section: Discussionmentioning

confidence: 96%

“…Given all the requirements for the tibial rotational reference in UKA, we suspected the AP axis of the tibia, described by Akagi et al [1], can be used as a tibial rotational reference. The AP axis connecting the middle of the PCL to the medial border of the patellar tendon attachment is a reproducible and reliable line because it is perpendicular to the SEA.…”

Section: Introductionmentioning

confidence: 99%

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Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Kawahara¹,

Matsuda²,

Okazaki³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique. Questions/purposes We explored whether the medial wall of the intercondylar notch could be useful for the tibial rotational reference as an alternative to the AP axis in unicompartmental knee arthroplasty. Methods We scanned the knees of 24 healthy Asian patients (45 knees) at a flexion angle of 908 using open MRI, then measured the angle between the AP axis and the medial wall of the notch. We determined whether the origins of the ACL and PCL were located lateral to the line on the medial wall of the notch and whether the mediolateral dimension of the bone cut surface of the medial tibial plateau was wide enough relative to the AP dimension to use the commercially available unicompartmental knee arthroplasty tibial components when the tibia was cut parallel to the medial wall of the notch.Results At 908 flexion the medial wall of the notch was externally rotated 0.18 ± 4.48 relative to the AP axis. In all knees, the ACL and PCL were located lateral to the line on the medial wall of the notch. The mediolateral dimension of the bone cut surface was wide enough to use the commercially available tibial components. Conclusions At 908 flexion the medial wall of the intercondylar notch is almost parallel to the AP axis of the tibia at and we believe a reasonable candidate for a rotational reference of tibial placement in unicompartmental knee arthroplasty. This landmark would need to be confirmed in other populations and in patients with osteoarthritis.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Kawahara¹,

Matsuda²,

Okazaki³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…More recently, various sagittal planes have been described including a line perpendicular to the posterior joint surface passing through the medial third of the tibial tubercle 7 and a line passing through the middle of the posterior cruciate ligament perpendicularly to the projected femoral transepicondylar axis (Akagi's line). 8 Unfortunately, many of these references vary among patients are difficult to establish and are, therefore, unreliable. The ROM technique aligns the tibial component according to the rotational alignment of the femoral component during trial…”

Section: Introductionmentioning

confidence: 99%

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Baldini

Indelli²,

Manfredini³

et al. 2014

The Duke Orthopaedic Journal

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Purpose: We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the 'Akagi' line and the medial third of the tibial tubercle.Methods: Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results:The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum -16°, maximum -7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum -4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum -1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion:Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence:Level 3 (Retrospective cohort study).

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“…The second approach, which avoids reference to anatomical landmarks, is the range-of-movement (ROM) technique, in which the knee is put through a full range of flexion and extension, allowing the trial tibial implant to orient itself in the best position relative to the femoral component [11]. The anatomical landmark technique has been reported to be reliable and reproducible by some authors [12,13] but not by others [1]. The ROM technique has been reported to be inappropriate for alignment of the tibial component as it leaves the component more internally rotated [11].…”

Section: Introductionmentioning

confidence: 99%

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Page

Deakin

Payne

et al. 2011

Computer Aided Surgery

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This study evaluated seven different frames of reference used for tibial component rotation in total knee arthroplasty (TKA) to determine which ones showed good reliability between bone specimens.An optoelectronic system based around a computer-assisted surgical navigation system was used to measure and locate 34 individual anatomical landmarks on 40 tibias. Each particular frame of reference was reconstructed from a group of data points taken from the surface of each bone. The transverse axis was used as the baseline to which the other axes were compared, and the differences in angular rotation between the other six reference frames and the transverse axis were calculated.There was high variability in the tibial rotational alignment associated with all frames of reference. Of the references widely used in current TKA procedures, the tibial tuberosity axis and the anterior condylar axis had lower standard deviations (6.1 and 7.3 , respectively) than the transmalleolar axis and the posterior condylar axis (9.3 for both). In conclusion, we found high variability in the frames of reference used for tibial rotation alignment. However, the anterior condylar axis and transverse axis may warrant further tests with the use of navigation. Combining different frames of reference such as the tibial tuberosity axis, anterior condylar axis and transverse axis may reduce the range of errors found in all of these measurements.

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An Anteroposterior Axis of the Tibia for Total Knee Arthroplasty

Cited by 384 publications

References 18 publications

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

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