Posterior Tibial Slope: Effect on, and Interaction with, Knee Kinematics

Ahmad, Riaz; Patel, A.; Mandalia, Vipul; Toms, Andrew

doi:10.2106/jbjs.rvw.o.00057

Cited by 41 publications

(29 citation statements)

References 32 publications

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“…Due to a large anatomical variability of the tibia, conventional precontoured plates often don’t adequately fit. As consequence, inadequate reductions and/or fixation can lead to malalignment and incongruity of the joint surface, and biomechanical and functional problems 23,27,28 . Correctly addressing tibial fractures is therefore increasingly accepted as an important prognostic factor for functional outcome 5 .…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variation of the Tibia – a Principal Component Analysis

Quintens

Herteleer

Vancleef

et al. 2019

Sci Rep

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Conventional anatomically contoured plates do not adequately fit most tibiae. This emphasizes the need for a more thorough morphological study. Statistical shape models are promising tools to display anatomical variations within a population. Herein, we aim to provide a better insight into the anatomical variations of the tibia and tibia plateau. Seventy-nine CT scans of tibiae were segmented, and a principal component analysis was performed. Five morphologically important parameters were measured on the 3D models of the mean tibial shapes as well as the −3SD and +3 SD tibial shapes of the first five components. Longer, wider tibiae are related to a more rounded course of the posterior column, a less prominent tip of the medial malleolus, and a more posteriorly directed fibular notch. Varus/valgus deformations and the angulation of the posterior tibia plateau represent only a small percentage of the total variation. Right and left tibiae are not always perfectly symmetrical, especially not at the level of the tibia plateau. The largest degree of anatomical variation of the tibia is found in its length and around the tibia plateau. Because of the large variation in the anatomy, a more patient-specific approach could improve implant fit, anatomical reduction, biomechanical stability and hardware-related complications.

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Section: Discussionmentioning

confidence: 99%

Anatomical Variation of the Tibia – a Principal Component Analysis

Quintens

Herteleer

Vancleef

et al. 2019

Sci Rep

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“…So, in our opinion, both sides' fracture pattern and patient's age suggested prosthetic replacement rather than osteosynthesis. Also, moderate EOA was present on the right side, and mild EOA on the left side; according to recent literature [[10], [11], [12], [13],23,24,[26], [27], [28]], RSA seems to improve clinical results with a better function over HA when poor potential for tuberosity healing is present (comminuted tuberosities, osteoporotic bone), also in mild or absent EOA. Lastly, treatment of concomitant bilateral proximal humeral fracture should rely on the same principles as for monolateral injury.…”

Section: Case Presentationmentioning

confidence: 79%

“…If surgical treatment is chosen, pre-operative planning should take into account Hertel's criteria [9] to predict the risk of humeral head avascular necrosis (AVN) and subsequent need for revision surgery in case of osteosynthesis. An increasing number of Authors suggest reverse shoulder arthroplasty (RSA) as a valid option instead of hemiarthroplasty (HA) or open reduction and internal fixation (ORIF) for the treatment of displaced fractures of humeral head in this population [[10], [11], [12], [13]], and a multicenter combined randomized controlled and observational trial on this issue has started [14]. In the rare situation of simultaneous bilateral proximal humeral fracture, choice of treatment is still more controversial, and it can vary from conservative management [15] to closed reduction and percutaneous fixation [16] to ORIF of one or both sides [17], to HA of one side associated to conservative treatment [18] or ORIF [5,18] or osteochondral autograft [19] of the contralateral side, to even bilateral HA [20,21].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report

Ceri

Mondanelli

Sangaletti

et al. 2019

Trauma Case Reports

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Background Proximal humeral fracture is the third most common fracture in elderly people after fractures of proximal femur and distal radius. They typically occur after low-energy trauma in women affected by osteoporosis, bilateral involvement is rare and usually with a simple pattern of fracture. Bilateral four-part proximal humerus fractures are even less frequent, with only a few reports published previously, with all of them caused by a seizure or electrocution in patients < 65 years old. Case presentation We present a 77-year-old right-handed female that sustained a bilateral simultaneous four-part humeral fracture secondary to accidental slip-and-fall occurred at home. Patient was treated with simultaneous bilateral Reverse Shoulder Arthroplasty (RSA) in our structure. Functional assessment was undertaken at 6- and 12-months follow-up (FU) after surgery, using the Constant-Murley score (CMS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Outcome The simultaneous RSA procedure was well tolerated by the patient. Post-operative course was optimal with relatively low blood loss, rapid functional recovery, and fast pain relief. The CMS and DASH score were reasonably good at 6-months FU (right-left: 39–57 and 50.8–30.5, respectively) and they further improved at 1-year FU (right-left: 66–82 and 35.8–19.2, respectively). X-rays showed good position of the implants with no evidence of scapular notching at 1 year. Patient rated the overall satisfaction as good. Discussion Bilateral four-part proximal humeral fractures are complex injuries difficult to manage. Optimal treatment is controversial, and it can be conservative or surgical, varying from open reduction and internal fixation (ORIF) to arthroplasty. However, this last option is still directed to only one side, preferring ORIF or conservative treatment for the contralateral. In case of comminute and displaced fractures, low bone quality, rotator cuff deficiencies and eccentric osteoarthritis, RSA is to prefer as a surgical option. For these reason, in selected cases of bilateral four parts proximal humerus fracture, especially when occurs in elderly patients, the simultaneous RSA implantation can represent a valid option to achieve an adequate functional result and a fast recovery. This is the first description, to our knowledge, in English literature of a simultaneous bilateral RSA.

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“…Accuracy of TS measurements also may be influenced by incorrect assessment of the tibial axis. 18 Faschingbauer et al 19 showed TS is most accurately measured with long lateral knee radiographs (defined as 16-20 cm of proximal tibia in view) and short view radiographs may overestimate TS by approximately 3 . The average length of the tibia in view in the current study was 17.4 and 14.9 cm in the skeletally mature and skeletally immature groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

The Blackburne–Peel Index for Determining Patellar Height Is Affected by Tibial Slope

Mortensen

Ludwig

Adams

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To establish a quantitative relationship between the BlackburneePeel index and posterior tibial slope in both skeletally mature and skeletally immature individuals and to evaluate the rate at which variation in tibial slope influences changes in patellar height categorization as normal, patella alta, and patella baja. Methods: A consecutive series of lateral knee radiographs were retrospectively reviewed. Radiographs were excluded for rotation, inadequate visible proximal tibia length, and obstructive hardware/pathology. Modified tibial slopes of 0 , 5 , 10 , and 15 were projected anteriorly from the medial tibial plateau as described by BlackburneePeel. The BlackburneePeel index was determined at each modified tibial slope interval. CatoneDeschamps and InsalleSalvati indices also were measured for comparison. The rate of BlackburneePeel index change with increase in posterior tibial slope was quantitatively analyzed. Results: Fifty skeletally mature and 50 skeletally immature radiographs were included. In the skeletally mature, BlackburneePeel indices decreased on average by 0.037, 0.044, and 0.049 as posterior tibial slope increased from 0-5 , 5-10 , and 10-15 , respectively. In the skeletally immature, BlackburneePeel indices decreased on average by 0.045, 0.053, and 0.059 as posterior tibial slope increased from 0-5 , 5-10 , and 10-15 , respectively. Overall, 29 individuals with 0 of tibial slope were categorized as patella alta by the BlackburneePeel index, and only 16 (55%) remained categorized as patella alta after increasing their posterior tibial slope to 15 . Conclusions: This study quantitatively demonstrates the relationship between posterior tibial slope and the BlackburneePeel index. As expected, as posterior tibial slope increases, the BlackburneePeel index decreases. While the change in the BlackburneePeel index per 5 change in tibial slope appears to be small, nearly half (45%) of individuals categorized as patella alta with 0 of tibial slope were categorized as normal when their posterior tibial slope was systematically increased from 0 to 15 . When evaluating patellar height, it is important to understand how tibial slope affects the Blackburne-Peel Index measurement. Clinical Relevance: As posterior tibial slope increases, the numerator of the Blackburne-Peel ratio decreases, and vice versa. This relationship can lead to incorrect assessment of patellar height. Objectively placing individuals into patella alta and baja categories may influence patient care and decision making. P atellar height is clinically relevant to several pathologic processes, including patellofemoral pain, chondromalacia, patellofemoral osteoarthritis, tibial tubercle apophysitis, patellar subluxation, and patellar dislocation. [1][2][3] Patellar height typically is assessed on lateral-view radiographs and sagittal plane imaging, and it is categorized as normal, patella alta, or patella baja. Patella alta describes a high-riding patella, whereas patella baja describes a low-riding patella.The InsalleSalvati inde...

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Posterior Tibial Slope: Effect on, and Interaction with, Knee Kinematics

Cited by 41 publications

References 32 publications

Anatomical Variation of the Tibia – a Principal Component Analysis

Anatomical Variation of the Tibia – a Principal Component Analysis

Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report

The Blackburne–Peel Index for Determining Patellar Height Is Affected by Tibial Slope

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