Can the tibial slope be measured on lateral knee radiographs?

Faschingbauer, M.; Sgroi, Mirco; Juchems, Markus; Reichel, Heiko; Kappe, Thomas

doi:10.1007/s00167-014-2864-1

Cited by 104 publications

(109 citation statements)

References 29 publications

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“…However, Akamatsu et al used nearly full length scans, in addition to short radiographs of the joint space, which included the majority of the tibia and enabled a more accurate determination of tibial slope [24]. Our results were consistent with those of Akamatsu et al for short radiographs [18].…”

Section: Discussionsupporting

confidence: 87%

“…The methods prescribed by Hashemi et al [11] referenced the mid-shaft of the tibia which is a function of the scan length of the MRI [24], while the novel 3D method referenced the most anterior point of the tibial tuberosity. Definition of the diaphyseal axis of the tibia inherently introduces error and may therefore yield inconsistent data [26] in a 2D approach.…”

Section: Discussionmentioning

confidence: 99%

“…Faschingbauer et al demonstrated that shorter shaft lengths (akin to shorter scan length) yielded significant variability in slope calculations (a difference of 7.5°) which was a function of the width of the diaphysis present in the scan, therein indicating that the axis is a function of proximal to distal image ‘scan length’ [24]. The location of the reference axis within the scan (i.e., more proximal or distal) also affected the tibial slope measurement.…”

Section: Discussionmentioning

confidence: 99%

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A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging

et al. 2017

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Background The proximal tibia is a geometrically complex, asymmetrical, and variable structure, is heavily implicated in arthrokinematics of the knee joint, and thus impacts weight-bearing knee biomechanics. Such variability and asymmetry may be implicated in knee pathologies such as non-contact anterior cruciate ligament injury. Medial, lateral, and coronal tibial slopes have been identified as anatomic parameters that may increase predisposition to knee injuries, but the extent to which each contributes has yet to be fully realized. Previously, two-dimensional methods have quantified tibial slopes, but more reliable 3D methods may prove advantageous. Aims The aims were: (1) to explore the reliability of two-dimensional methods, (2) to propose a novel three-dimensional measurement approach, and (3) to compare the data derived from traditional and novel methods. Methods Medial, lateral, and coronal tibial slope geometry from both knees (left and right) of one subject were obtained via magnetic resonance images and measured by four trained observers from two-dimensional views. The process was repeated via three-dimensional approaches and data were evaluated for intra- and inter- rater reliability. Results The conventional method presented a weaker Intraclass Correlation Coefficient (ICC) for the measured slopes (ranging from 0.43 to 0.81) while the resultant ICC for the proposed method indicated greater reliability (ranging from 0.84 to 0.97). Statistical analysis supported the novel three-dimensional approach for production of more reliable and repeatable results for each of the slopes calculated. Conclusions The novel three-dimensional method for calculating tibial plateau slope may be more reliable than previously established methods and may provide an important tool during assessment of knee injury risk, susceptibility to osteoarthritis, as part of anterior cruciate ligament injury risk assessment, and in design of total knee implants.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging

et al. 2017

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“…In general, long lateral knee radiographs should be preferred over short radiographs. 16 If MRI is used, the circle method described by Hudek et al 26 may be the preferred method since it has been shown to be the most repeatable method. 35 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

Tischer

Paul²,

Pape

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability.Hypothesis/Purpose:The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases.Study Design:Systematic review; Level of evidence, 4.Methods:According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS).Results:Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes.Conclusion:In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis.

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“…Dazu wurden die Resektionsebenen am Femur 90°zur mechanischen Femurachse und an der Tibia 90°zur mechanischen Tibiaachse geplant. Der tibiale Slope wurde auf langen lateralen Röntgenaufnahmen als Winkel zwischen der Tangente des medialen und lateralen Tibiaplateaus und der diaphysären Mittelpunkte 5 und 15 cm unterhalb des Tibiaplateaus gemessen [16,17]. Alle Operationen wurden durch 1 Operateur (C. P.) durchgeführt.…”

Section: Op-technikunclassified

Gibt es die ideale Knietotalendoprothese für jüngere Patienten?

et al. 2014

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The data of this study show improved early functional results in younger patients in comparison to the current literature. However, until now no existing TKA system can be identified as ideal. But taking recent biomechanical knowledge into consideration, modern TKA designs have the potential to improve the functional outcome. Especially for younger patients with superior muscle-status and coordinative abilities this seems beneficial.

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Can the tibial slope be measured on lateral knee radiographs?

Abstract: Diagnostic study, Level II.

Cited by 104 publications

References 29 publications

A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging

A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

Gibt es die ideale Knietotalendoprothese für jüngere Patienten?

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