Fibula head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty

Jawhar, Ahmed; Wasnik, Sandeep; Scharf, Hanns‐Peter; Roehl, Henning

doi:10.1007/s00264-013-2100-5

Cited by 11 publications

(13 citation statements)

References 33 publications

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“…One more reason that CR TKA is not preferred is that most of the PCL insertion is likely to be sacrificed fully or partially during preparation of the tibial plateau, 14,15 which will potentially influence the clinical outcome. Although many landmarks, such as fibula head, 16 had been proposed to improve the procedure, priority should always be given to a more insured surgical technique. The present study might play a role in providing the basic experimental evidence, supporting the results of a better outcome after the resection of PCL.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of posterior cruciate ligament in total knee arthroplasty

Chen

Nagamine

2017

J Orthop Surg (Hong Kong)

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Introduction: It has been realized that for osteoarthritis (OA) knee with varus deformity, posterior cruciate ligament (PCL) release resulted in the increase of the flexion gap without significant effect on the extension gap. While the effect of release on gap angle is still obscure. On the other hand, gap distance and varus angle measured under different distraction forces suggest different patterns. Objectives: In the current study, mechanical gap balance in displacement and angular alternation of extension and flexion gaps will be evaluated, with PCL fully retained or resected under different distracting forces in varus knees. Methods: Fifty cases with medial OA undergoing posterior-stabilized (PS) total knee arthroplasty (TKA) were included in the study. PCL of all the cases were identified intact before resection. After distal femoral and proximal tibial cuts were initially performed and anterior cruciate ligament was excised, joint gap angle and distance in full extension and at 90 flexion were obtained by means of a tensioning device with 10, 20 and 30 inch-pounds (in-lbf) of distraction force. The gap angle and distance were measured three times at each step. After the excision of PCL, the same measurement was performed. Results: Both the distance and the varus angles of the knee gap enlarged accordingly with the augment of distraction forces at both extension and flexion with or without PCL resection. As to the gap distance, it remained the same after PCL resection at extension; while at flexion, the gap distance significantly (p < 0.001) enlarged -1.2, 1.6 and 1.9 mm -under 10, 20 and 30 in-lbf, respectively, after PCL resection. As to the varus angles, it significantly (p < .050) decreased 0.6 , 0.3 and 0.4 at extension; while at flexion, the varus angles decreased 0 (not significant), 0.6 (p < 0.050) and 1.1 (p < 0.001) with 10, 20 and 30 in-lbf, respectively, after PCL resection. Conclusion: Our study indicated that the sacrifice of PCL will decrease the varus deformity at both extension and flexion, but with the exception under low distraction force at flexion. A proper distraction tension is of great importance in gap balancing during TKA. Sufficient attention of varus differences should be paid to the gap balance technique when choosing from different techniques, PCL-retained TKA or PCL-sacrificed TKA, as well as and an appropriate distract tension during measurement.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of posterior cruciate ligament in total knee arthroplasty

Chen

Nagamine

2017

J Orthop Surg (Hong Kong)

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“…The JL can be rebuilt relative to the existing TKA but carries the risk of reconstructing a JL that was already altered in primary surgery. Therefore, anatomical landmarks to reconstruct the JL were published: for the fibular head (FH), a distance to the JL of 10 mm is reported [7,8]. Stiehl and Abott [9] investigated the distal femoral anatomy and found a mean distance from the medial and lateral (epi)condyle to the JL of 30.8 and 25.3 mm, respectively.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study

Maderbacher

Keshmiri

Schaumburger

et al. 2014

International Orthopaedics (SICOT)

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Purpose Restoring the joint line (JL) improves clinical and functional outcome in total knee arthroplasty (TKA). Therefore, anatomical landmarks to approximate the JL have been published. So far, the natural deviation of the JL 90°to the mechanical tibial axis has not been considered. Thus, we designed this study to: (1) determine the natural JL of knees in healthy persons in respect to the mechanical tibial axis, (2) validate and double-check intra-operative bony landmarks already been published in respect to the natural JL and (3) find possible correlations between distances from bony landmarks to the JL and femoral and tibial width. Methods Eighty MRI scans of knees of healthy persons were examined by two independent observers. Distances from the tip of the fibular head (FH), the medial (ME) and lateral (LE) epicondyles and the adductor tubercle (AT) to the JL within the medial and lateral compartment were measured. Further, we determined the orientation of the JL in respect to the mechanical axis of the tibia. Interobserver correlations were calculated. Differences were analyzed using Student's t test. Linear regression models were calculated to analyze correlations. Results Interobserver correlation was excellent. Mean JL deviation was 4.2°varus. Distance between the FH, ME, LE and AT to the JL within the medial compartment was 12.2, 33.9, 33.4 and 45.4 mm, respectively. Within in the lateral compartment, distances were 15.3, 31.0, 30.6 and 42.3 mm to the JL. Strong correlation was found between femoral width and distances from the AT, ME and LE to the JL. ConclusionIn TKA, the JL is usually altered due to the classic resection technique, which does not respect the natural deviation of the JL. Estimating the natural JL by adding absolute values to bony landmarks, as proposed in the literature, is not recommended. According to our data, the JL can be best estimated by adding the calculated value: 6.40+(width femur [mm] × 0.49) to the AT.

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“…Average, median, range, standard deviation and distribution were calculated for all parameters. The power analysis (a priori) was performed according to the previously published data [9]. The power analysis (post hoc) was based on a calculated effect size of 0.23.…”

Section: Discussionmentioning

confidence: 99%

“…Results The vertical distance between the tibial tuberosity and tibial cut averaged 24.7 ± 4 mm. The average vertical Few reports indicate a partial or a total PCL damage after a routine tibial osteotomy during TKA [3,9,16].…”

Section: Introductionmentioning

confidence: 99%

Preservation of the PCL when performing cruciate-retaining TKA: Is the tibial tuberosity a reliable predictor of the PCL footprint location?

Jawhar

Kadavkolan²,

Wasnik³

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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Fibula head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty

Abstract: Currently available routine tibial preparation techniques result in partial or total posterior cruciate ligament detachment. Fibula head as a landmark aids to predict the PCL location and to estimate its disruption pre- and postoperatively on AP-view radiographs.

Cited by 11 publications

References 33 publications

Comparative evaluation of posterior cruciate ligament in total knee arthroplasty

Comparative evaluation of posterior cruciate ligament in total knee arthroplasty

Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study

Preservation of the PCL when performing cruciate-retaining TKA: Is the tibial tuberosity a reliable predictor of the PCL footprint location?

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