Different rotational alignment of tibial component should be selected for varied tibial tubercle locations in total knee arthroplasty

Dai, Yike; Ma, Tiancai; Yin, Hao; Xu, Chunyan; Zhang, Hongrui; Ai, Guo; Diao, Naicheng

doi:10.1007/s00167-021-06774-7

Cited by 5 publications

(4 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, TT-TG distance can be affected by knee rotation, which is one of the most important factors affecting PD. 1 , 5 , 14 , 20 , 28 , 40 , 44 TT-TG distance has often been questioned when evaluating TTL.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Tibial Tubercle–Trochlear Groove Distance for Assessing Tibial Tubercle Lateralization: A Study Comparing Different Anatomic References

Li,

Xu,

Dong

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The tibial tubercle–trochlear groove (TT-TG) distance is a measurement used to quantitatively assess tibial tubercle lateralization (TTL), and it has important reference value for the treatment of patellar dislocation (PD). However, TT-TG distance accuracy has been questioned, so many new parameters have been proposed. Purpose: To compare which of the TT-TG, tibial tubercle–midepicondyle (TT-ME), tibial tubercle–Roman arch (TT-RA), tibial tubercle–tibial intercondylar midpoint (TT-TIM), and tibial tubercle–mid inter-epicondyle trochlea intersection (TT-MIELTI) distances better reflect TTL in patients with PD. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 96 patients who had undergone surgery for PD and 96 patients without PD (controls) were included in the study. The patients had all undergone computed tomography examination. The TT-TG, TT-ME, TT-RA, TT-TIM, TT-MIELTI distances and the TTL distance were measured independently by 2 surgeons in a blinded and randomized fashion. The t test was used to detect whether the parameters were significantly different between the 2 groups. The TTL distance was used as a reference value for lateralization of tibial tubercle. Pearson correlation coefficients were calculated to determine correlations between the defined measurements. Results: The intra- and interobserver reliability of the defined measurements was excellent. All parameters except for TT-TIM distance were significantly larger in the PD group than the control group ( P < .01 for all). There was a moderate correlation ( r = 0.601) between the TT-TG distance and TTL, and other parameters were less correlated with TTL. Conclusion: Among 5 the parameters tested, the TT-TG distance still had the highest correlation with TTL and was able to reflect TTL better in patients with PD. The role of TT-TIM distance in the assessment of PD needs further study.

show abstract

Section: Discussionmentioning

confidence: 99%

Reliability of Tibial Tubercle–Trochlear Groove Distance for Assessing Tibial Tubercle Lateralization: A Study Comparing Different Anatomic References

Li,

Xu,

Dong

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…On the tibial side, due to the inability of the surgeons to locate the SEA directly on the proximal tibial osteotomy surface, the researchers have attempted to establish optimal tibial rotational axes using appropriate intra- or extra-articular anatomical landmarks, such as the medial boundary of the tibial tuberosity [ 16 , 20 ], the medial third boundary of the tibial tuberosity [ 20 , 23 ], the anterior cortex of the tibia [ 16 ], the anterior tibial crest [ 19 , 21 ] and the tibial posterior condylar [ 23 , 25 , 26 ]. However, there is still a lack of consensus on tibial rotational alignment due to the low confidence and high individual variability of reference axes [ 13 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is often impossible to identify the posterior cruciate ligament termination after proximal tibial osteotomy. In addition, it was found that the accuracy of the Akagi line differed among the female and male [ 19 , 23 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Zhang

Zhou

et al. 2022

J Orthop Surg Res

View full text Add to dashboard Cite

Purpose This study was carried out to investigate the accuracy of referring different locations of the patellar tendon attachment site and the geometrical center of the osteotomy surface for tibial rotational alignment and observe the influences of gender differences on the results. Methods Computed tomography scans of 135 osteoarthritis patients (82 females and 53 males) with varus deformity was obtained to reconstruct three-dimensional (3D) models preoperatively. The medial boundary, medial one-sixth, and medial one-third of the patellar tendon attachment site were marked on the tibia. These points were projected on the tibial osteotomy plane and connected to the geometrical center (GC) of the osteotomy plane or the middle of the posterior cruciate ligament (PCL) to construct six tibial rotational axes (Akagi line, MBPT, MSPT1, MSPT2, MTPT1 and MTPT2). The mismatch angle between the vertical line of the SEA projected on the proximal tibial osteotomy surface and six different reference axes was measured. In additional, the effect of gender differences on rotational alignment for tibial component were assessed. Results Relative to the SEA, rotational mismatch angles were − 1.8° ± 5.1° (Akagi line), − 2.5° ± 5.3° (MBPT), 2.8° ± 5.3° (MSPT1), 4.5° ± 5.4° (MSPT2), 7.3° ± 5.4° (MTPT1), and 11.6° ± 5.8° (MTPT2) for different tibial rotational axes in all patients. All measurements differed significantly between the male and female. The tibial rotational axes with the least mean absolute deviation for the female or male were Akagi line or MSPT, respectively. There was no significant difference in whether the GC of the osteotomy surface or the midpoint of PCL termination was chosen as the posterior anatomical landmark when the medial boundary or medial one-sixth point of the patellar tendon attachment site was selected as the anterior anatomical landmark. Conclusion When referring patellar tendon attachment site as anterior anatomical landmarks for tibial rotational alignment, the influence of gender difference on the accuracy needs to be taken into account. The geometric center of the tibial osteotomy plane can be used as a substitute for the middle of the PCL termination when reference the medial boundary or medial one-sixth of the patellar tendon attachment site.

show abstract

“…Reasons for persistent patellofemoral pain include lateral patellar maltracking, problems related to the extensor mechanism, and less frequently patellofemoral instability [22, 24, 30]. Contrary to the extensive research that has been conducted on the influence of femoral rotation and tibial base plate positioning on the patellofemoral joint, it seems that little attention has been paid to the tibial tuberosity trochlear groove distance (TTTG), as there are but few studies specifically investigating TTTG in TKA [15, 16, 20, 26, 34, 37]. The TTTG was first described on plain radiographs by Goutallier in 1978 as “The line between the summit of the tibial tuberosity and the bottom of the trochlea groove as seen on a radiograph taken with the knee in 30 degrees of flexion and neutral rotation”.…”

Section: Introductionmentioning

confidence: 99%

Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty

Zimmermann

Scherrer

Zaleski³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeAnterior knee pain (AKP) is common following total knee arthroplasty. The tibial tuberosity trochlear groove distance (TTTG) influences patellofemoral joint loading in the native knee. Increased TTTG may lead to maltracking of the patella and anterior knee pain. The purpose of this study was to investigate potential changes in TTTG following total knee arthroplasty (TKA). MethodsTTTG was measured on preoperative CT data on a consecutive series of patients scheduled to receive TKA with patient‐specific instrumentation, and compared to a computer simulation of the postoperative TTTG. Preoperative TTTG was measured with a 3D planning software in 250 knees. The postoperative result was simulated and TTTG measured within the software. Three different groups were analysed: neutral (180° ± 3) (n = 50), valgus (> 190°) (n = 100), and varus (< 170°) (n = 100). ResultsMedian preoperative to simulated postoperative TTTG decreased from 15.0 [interquartile range (IQR) 6.0] mm to 6.5 (IQR 5.0) mm for all axes combined. A significant postoperative reduction of TTTG was found in each group (p < 0.001). The mean change in TTTG did not differ significantly between the groups [− 8.8 (IQR 5.5) mm neutral, − 8.3 (IQR 7.0) mm valgus, − 7.5 (IQR 5.8) mm varus, p = 0.223]. ConclusionThis computer‐based study suggests that mechanically aligned TKA significantly decreases TTTG distance in neutral, valgus and varus knees, assuming that the postoperative result coincides with the preoperative planning. Further study is warranted to evaluate the clinical relevance of this finding.

show abstract

Different rotational alignment of tibial component should be selected for varied tibial tubercle locations in total knee arthroplasty

Cited by 5 publications

References 37 publications

Reliability of Tibial Tubercle–Trochlear Groove Distance for Assessing Tibial Tubercle Lateralization: A Study Comparing Different Anatomic References

Reliability of Tibial Tubercle–Trochlear Groove Distance for Assessing Tibial Tubercle Lateralization: A Study Comparing Different Anatomic References

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty

Contact Info

Product

Resources

About