Skip to main content

12.05.2017 | Knee | Ausgabe 5/2018 Open Access

Knee Surgery, Sports Traumatology, Arthroscopy 5/2018

Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics: a musculoskeletal simulation study

Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 5/2018
Marco A. Marra, Marta Strzelczak, Petra J. C. Heesterbeek, Sebastiaan A. W. van de Groes, Dennis W. Janssen, Bart F. J. M. Koopman, Ate B. Wymenga, Nico J. J. Verdonschot
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00167-017-4561-3) contains supplementary material, which is available to authorized users.



In total knee arthroplasty (TKA), the posterior tibial slope is not always reconstructed correctly, and the knee ligaments may become too tight in flexion. To release a tight flexion gap, surgeons can increase the posterior tibial slope using two surgical resection techniques: the anterior tibial cortex (ACR) or the centre of tibial plateau (CPR) referencing. It is not known how this choice affects the knee laxity and function during activities of daily living. The aim of this study was to investigate the effect of tibial slope on knee laxity, kinematics and forces during a squatting activity using computer simulation techniques. We hypothesised that the effects depend on the referencing technique utilised.


A validated musculoskeletal model of TKA was used. Knee laxity tests were simulated in flexion and extension. Then, a squat motion was simulated to calculate: movement of the tibiofemoral joint (TFJ) contact points and patello-femoral joint (PFJ) contact force. All analyses were repeated with more anterior (−3°), neutral (0°), and more posterior tibial slope (+3°, +6°, +9°), and with two referencing techniques (ACR, CPR).


Knee laxities increased dramatically with more posterior slope with the ACR technique (up to 400%), both in flexion and in extension. The CPR technique, instead, had much smaller effects (up to 42% variations). During squatting, more slope with the ACR technique resulted in larger movements of the TFJ contact point. The PFJ contact force decreased considerably with more slope with the CPR technique (12% body weight reduction every 3° more posterior slope), thanks to the preservation of the patellar height and quadriceps–femur load sharing.


ACR technique alters considerably the knee laxity, both in flexion and extensions, and surgeons should be cautious about its use. More slope with CPR technique induces more favourable TFJ kinematics and loading of the knee extensor apparatus and does not substantially alter knee laxity. Preferably, the tibial slope resection should be pre-planned thoroughly and performed using CPR technique as accurately as possible. Surgeons can directly translate the results of this study into the clinical practice.

Unsere Produktempfehlungen

e.Med Interdisziplinär


Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

e.Med Orthopädie & Unfallchirurgie


Mit e.Med Orthopädie & Unfallchirurgie erhalten Sie Zugang zu CME-Fortbildungen der Fachgebiete, den Premium-Inhalten der dazugehörigen Fachzeitschriften, inklusive einer gedruckten Zeitschrift Ihrer Wahl.

Supplementary material 1 (DOCX 39 kb)
Supplementary material 2 (WMV 16814 kb)
Supplementary material 3 (WMV 33853 kb)
Über diesen Artikel

Weitere Artikel der Ausgabe 5/2018

Knee Surgery, Sports Traumatology, Arthroscopy 5/2018 Zur Ausgabe

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.