Mo Saffarini1, Luca Nover2, Reha Tandogan3, Roland Becker4, Lukas B Moser5, Michael T Hirschmann5, Pier F Indelli6. 1. ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland. journals@resurg.eu. 2. ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland. 3. Çankaya Orthopedics, Ankara, Turkey. 4. Bundesanstalt für Materialforschung und-prüfung (BAM), Berlin, Germany. 5. Kantonsspital Baselland, Bruderholz, Basel, Switzerland. 6. Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, USA.
Abstract
PURPOSE: There is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA. METHODS: Medline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated. RESULTS: The selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border. CONCLUSIONS: Because of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE: Level IV, systematic review of level III and IV studies.
PURPOSE: There is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA. METHODS: Medline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated. RESULTS: The selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border. CONCLUSIONS: Because of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE: Level IV, systematic review of level III and IV studies.
Authors: Roman Popescu; Stefan Cristea; Valentin Oleksik; Adrian Marius Pascu; Emil George Haritinian Journal: J Appl Biomed Date: 2021-09-20 Impact factor: 1.797
Authors: Lucas Beckers; Jacobus H Müller; Jeremy Daxhelet; Salvatore Ratano; Mo Saffarini; Tarik Aït-Si-Selmi; Michel P Bonnin Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-06-01 Impact factor: 4.342
Authors: Patrick Schafer; Ali Mehaidli; Mark Zekaj; Muhammad T Padela; Syed Ahmad Rizvi; Chaoyang Chen; Zain Sayeed; Hussein Darwiche Journal: J Orthop Date: 2020-06-04
Authors: Reha N Tandogan; Nanne P Kort; Ersin Ercin; Floris van Rooij; Luca Nover; Mo Saffarini; Michael T Hirschmann; Roland Becker; David Dejour Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-03-01 Impact factor: 4.114