The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty

Iacono, Francesco; Raspugli, Giovanni Francesco; Filardo, Giuseppe; Bruni, Danilo; Zaffagnini, Stefano; Bignozzi, S.; Presti, Mirco Lo; Akkawi, Ibrahim; Neri, Maria Pia; Marcacci, Maurilio

doi:10.1007/s00167-015-3556-1

Cited by 20 publications

(26 citation statements)

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“…Intra-operative methods for locating the joint line using the epicondyles have been previously described: those reporting approximate distance values 5 , 21 or ratios. 2 , 10 , 17 , 22 , 23 The idea of creating ratios on this subject depends on the fact that owing to ethnic and anthropometric variation, the dimensions of the distal femur may differ between individuals. However, the ratio between the TEW and the epicondyle-joint line distance is not affected by anthropometric properties such as height and gender and was consistent between patients.…”

Section: Discussionmentioning

confidence: 99%

“…Also, some authors have suggested that epicondyle determination may be difficult due to excessive soft tissues, fibrosis and scarring overlying the epicondyles, loss of bone and the operator-dependent factors associated with the surgeons’ ability to pinpoint identification accurately. 10 , 19 , 22 , 26 - 28 However, others have concluded that the epicondyles are reliable and easily identifiable intra-operative bony landmarks in TKA. 22 , 23 , 29 The superficial soft tissues covering the epicondyles can be dissected up to the collateral ligaments as a part of standard surgical exposure and debridement.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 19 , 22 , 26 - 28 However, others have concluded that the epicondyles are reliable and easily identifiable intra-operative bony landmarks in TKA. 22 , 23 , 29 The superficial soft tissues covering the epicondyles can be dissected up to the collateral ligaments as a part of standard surgical exposure and debridement. In revision TKA surgery, dissection of the distal femur is usually more extensive than in primary TKA cases, allowing easy identification of the medial and lateral epicondyles.…”

Section: Discussionmentioning

confidence: 99%

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The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Özkurt

Sen

Çankaya

et al. 2016

Bone & Joint Research

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ObjectivesThe purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty.MethodsThe transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated.ResultsThe mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively.ConclusionThis method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Özkurt

Sen

Çankaya

et al. 2016

Bone & Joint Research

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“…Das Verschiebung der Gelenklinie anhand verschiedener Landmarken evaluiert werden (30 % der transepikondylären Achse nach distal, Fibulaköpfchen, Tuberculum adductorium, Patellahöhen-stand) [45][46][47]. Auf den seitlichen Aufnahmen kann eine Veränderung des anterioren oder posterioren femoralen Offsets identifiziert werden.…”

Section: Diskussionunclassified

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

et al. 2015

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Basic building blocks are the medical history with the core issues of pain character and the time curve of pain concerning surgery. This is followed by the basic diagnostics, including clinical, radiological, and infectiological investigations. Unique failures like periprosthetic infection or aseptic loosening can thereby be diagnosed in the majority of cases. If the cause of pain is not clearly attributable using the basic diagnostics tool, further infectiological investigation or diagnostic imaging are necessary. If the findings are inconsistent, uncommon causes of symptoms, such as extra-articular pathologies, causalgia or arthrofibrosis, have to be considered. In cases of ongoing unexplained pain, a revision is not indicated. These patients should be re-evaluated after a period of time.

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“…Determining the articular level using plain radiographs is possible by measuring the absolute distance between a reference bone landmark and the tangent to the JL. 7 The most commonly used bony landmarks are the epicondyles, tip of the fibula head, tibial tubercle and the inferior pole of the patella. 1 , 3 , 6 , 8 , 9 Recently, the adductor tubercle has been presented as a new bony landmark and the most useful, in determining the articular level in revision knee arthroplasty cases.…”

mentioning

confidence: 99%

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?

Boya

Arac

2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveIn our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level.MethodsData from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight-bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test.ResultsMost of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 ± 0.031 and Mean AR in Group 1: 0.502 ± 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined.ConclusionIn conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients.Level of evidenceLevel III, Diagnostic study.

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The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty

Abstract: Case series, Level IV.

Cited by 20 publications

References 26 publications

The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?

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