Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography

Zhang, Kesong; Han, Qing; Wang, Hecheng; Yang, Ke; Chen, Bingpeng; Zhang, Yong; Zhang, Shiruo; Wang, Jincheng; H, Chu

doi:10.1097/md.0000000000017508

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…Therefore, the stable fixation of the fragment could be achieved by the strong support of the filled calcium sulfate bone graft substitute and the rigid fixation of screws or plates. The mean TPA at the final follow-up was 9.7°± 3.5°compared to the normal northeast Chinese lateral TPA of 8.44°± 2.76°, and no posterolateral instability of the knee joint was found, which implies that the fixation was rigid enough, and no significant subsidence of the articular fracture fragments happened after a full weight-bearing activities [26].…”

Section: Discussionmentioning

confidence: 66%

A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures

Yang

Zhou

et al. 2020

J Orthop Surg Res

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Background: Posterolateral tibial plateau fractures (PTPF) remain a challenge for orthopedics surgeons because the special anatomical structures of the posterolateral corner of knee joint including the fibular head, the lateral collateral ligament, and the peroneal nerve, which impedes the exposure of the fracture fragments and need irregular implants to get a stable fixation. The purpose of present study was to introduce a new articular fracture fragments restoration technique for three patterns of PTPF and investigate the relationship between associated soft injuries and fracture patterns. Methods: From May 2016 to April 2018, 31 patients with PTPF who had undertaken arthroscopically assisted reduction and fixation (AARF) were enrolled in present study. Demographic data, pre-operation, and post-operation X plan films, three-dimensional computed tomography (CT) scans and magnetic resonance imaging (MRI) were reviewed. Present samples were divided into three patterns with lateral inclination (LI), posterior inclination (PI), and parallel compression (PC) according to the orientation of the articular fragment inclination. Rasmussen anatomical score was used to assess the radiological results. Rasmussen functional score, Hospital for Special Surgery knee-rating Score (HSS), and range of motion (ROM) of the knee joint at the final follow-up were measured to evaluate the clinical outcomes. Results: In this series, the post-operation tibial plateau angle (TPA) was 9.7°± 3.5°(range 4.0°-15.8°) and the Rasmussen anatomical score was 17.7 ± 0.7(range 16-18); clinical outcomes showed that the HSS score was 92.7 ± 21.8 (range 90-96) and the Rasmussen functional score was 27.9 ± 1.0 (range 26-30). Of all the patients, the anterior cruciate ligament (ACL) injuries including the ACL tibial attachment ruptures occurred in 16 patients (51.6%), meniscus lesions happened in 19 patients (61.3%), medial collateral ligament (MCL) injuries were founded in 13 patients (41.9%). The number of ACL injuries including the ACL tibial attachment ruptures in the PI fracture pattern (12 cases) is significantly higher than LI (2 cases) and PC (2 cases) fracture pattern (p < 0.05). Conclusion: Profound understanding the different patterns of PTPF and using our reduction technique will facilitate to restore the main articular fracture fragments. The PI fracture patterns have a significant high incidence of the ACL ruptures.

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Section: Discussionmentioning

confidence: 66%

A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures

Yang

Zhou

et al. 2020

J Orthop Surg Res

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“…In this study, the mean TT-PCL distance was 19.2 ± 4.3 mm, which was smaller than the previous measurement based on 3D models [ 19 ]. The difference may be caused by the factor of ethnicity [ 30 ]. An optimal cut-off value (19 mm) of TT-PCL distance was found in the safe zone (-5°-10°) to combine the selection of the Akagi line and MTTT.…”

Section: Discussionmentioning

confidence: 99%

Different tibial rotational axes can be applied in combination according to the tibial tuberosity–posterior cruciate ligament distance in total knee arthroplasty

Zhang

Zhou

Zhang

et al. 2022

BMC Musculoskelet Disord

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Purpose The purpose of this study was to investigate whether tibial tuberosity–posterior cruciate ligament (TT-PCL) distance is representative of the true lateralization of tibial tuberosity in isolation and its influence on the accuracy of the Akagi line and medial third of the tibial tuberosity (MTTT). Methods A total of 135 osteoarthritis patients with varus knees who undergoing computed tomography scans were enrolled to establish three-dimension models of the knees. Tibial width (TW), tibial tuberosity lateralization (TTL), posterior cruciate ligament lateralization (PCLL), knee rotation angle (KRA) and tibial rotational axes were measured and investigated their correlations with TT-PCL distance. Based on the analysis of receiver operating characteristic (ROC) curve, the influence of TT-PCL distance on the distributions of mismatch angles of tibial rotational axes was investigated with a safe zone (-5° to 10°). Results TT-PCL distance was in significantly positive correlation with TW (r = 0.493; P < 0.001) and TTL (r = 0.378; P < 0.001) which was different with PCLL (r = 0.147; P = 0.009) and KRA (r = -0.166; P = 0.054). All tibial rotational axes were significantly positively correlated with TT-PCL distance (P < 0.001). The mismatch angles between the vertical line of the surgical epicondylar axis (SEA) and the Akagi line and MTTT were -1.7° ± 5.3° and 7.6° ± 5.6° respectively. In terms of the optimal cut-off value of 19 mm for TT-PCL distance, the Akagi line applied as tibial rotational axis ensures 87.3% of the positions of tibial components within the safe zone when TT-PCL distance > 19 mm, and MTTT ensures 83.3% when TT-PCL distance ≤ 19 mm. Conclusion TT-PCL distances cannot reflect the true lateralization of tibial tuberosity in isolation but can aid in the combination of the Akagi line and MTTT in varus knees. The patients with TT-PCL distance > 19 mm are recommended to reference the Akagi line for tibial rotational alignment. MTTT is recommended to the patients with TT-PCL distance ≤ 19 mm. The study will aid surgeons in deciding which reference may be used by measuring TT-PCL distance using a preoperative CT.

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“…Although the geometric ratios of four commonly implanted tibial baseplates could accommodate a large proportion of the observed morphologic variability, it is important to note that a surgeon generally only uses one or a few TKA brands, which makes it diicult to avoid bone-implant mismatch in all knees. Tibial AP and ML dimensions are signiicantly diferent among men and women, and between races [1,2,9,10,18,26,30,33,37,41,43,50,53]. One study found a strong correlation between the ML width and AP length at the medial and lateral compartments, but observed minimal diferences in correlations on the basis of sex and race [13].…”

Section: Discussionmentioning

confidence: 99%

Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

Beckers

Müller

Daxhelet

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this systematic review and meta‐analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially‐available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. MethodsThis systematic review and meta‐analysis was performed according to the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially‐available tibial baseplates. ResultsA total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African‐Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African‐Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone‐implant mismatch of > 3 mm overhang or > 4 mm under‐coverage with four commercially‐available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17–100% of knees) and asymmetry ratio (in 7–100% of knees). ConclusionAnthropometric studies reported considerable inter‐individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone–implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient‐specific implants to potentially achieve accurate bone–implant fit by implant customisation. Level of evidenceIV.

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Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography

Cited by 11 publications

References 26 publications

A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures

A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures

Different tibial rotational axes can be applied in combination according to the tibial tuberosity–posterior cruciate ligament distance in total knee arthroplasty

Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

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