nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

27.01.2022 | KNEE

Medial proximal tibial angle at the posterior tibial plateau represents the pre-arthritic constitutional medial proximal tibial angle in anterior cruciate ligament-intact, advanced osteoarthritis of the knee

verfasst von: Hiroyasu Ogawa, Yutaka Nakamura, Masaya Sengoku, Tetsuya Shimokawa, Kazuki Sohmiya, Kazuichiro Ohnishi, Kazu Matsumoto, Haruhiko Akiyama

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 9/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In kinematically aligned total knee arthroplasty (TKA), it is necessary to infer the pre-arthritic constitutional medial proximal tibial angle (MPTA) in advanced osteoarthritis (OA) of the knee with bone loss. The aim of this study was to investigate whether MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA in anterior cruciate ligament (ACL)-intact, advanced OA knees. It was hypothesized that MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA of ACL-intact, advanced knee OA.

Methods

One hundred varus, anterior cruciate ligament (ACL)-intact, advanced OA knees were analysed. The hip–knee–ankle (HKA) angle and MPTA were assessed on computed radiography (CR) and MPTAs at the anterior, middle, and posterior part of the tibial plateau were assessed on computed tomography (CT) images. The association between these parameters was also analysed.

Results

CR images showed an HKA angle of 172.4 ± 4.1° and MPTA of 84.3 ± 2.5°. CT images showed different MPTAs in the three regions, ranging from 83.9 ± 2.4° to 85.9 ± 2.8°. The middle MPTA was the lowest at 83.9 ± 2.4°. HKA angle correlated with the middle MPTA (r = 0.3355, 95% confidence interval [CI] 0.1489–0.4991, p = 0.0006) and ΔMPTA (Middle-Posterior) (r = 0.5128, 95% CI 0.3518–0.6443, p < 0.0001).

Conclusion

The MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA in ACL-intact, advanced OA knees.

Level of evidence

III, retrospective cohort study.

Almaawi AM, Hutt JRB, Masse V, Lavigne M, Vendittoli PA (2017) The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplast 32:2133–2140. https://doi.org/10.1016/j.arth.2017.02.028CrossRef

Blakeney W, Beaulieu Y, Kiss MO, Rivière C, Vendittoli PA (2019) Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans. Acta Orthop 90:602–609. https://doi.org/10.1080/17453674.2019.1675126CrossRefPubMedPubMedCentral

Calek AK, Hochreiter B, Hess S, Amsler F, Leclerq V, Hirschmann MT, Behrend H (2021) High inter- and intraindividual differences in medial and lateral posterior tibial slope are not reproduced accurately by conventional TKA alignment techniques. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06477-zCrossRefPubMed

Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M (2017) PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 25:1743–1748. https://doi.org/10.1007/s00167-016-4136-8CrossRefPubMed

Delport H, Labey L, Innocenti B, De Corte R, Vander Sloten J, Bellemans J (2015) Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments. Knee Surg Sports Traumatol Arthrosc 23:2159–2169. https://doi.org/10.1007/s00167-014-2971-zCrossRefPubMed

Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT (2019) Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:1368–1377. https://doi.org/10.1007/s00167-019-05506-2CrossRefPubMed

Hess S, Moser LB, Robertson EL, Behrend H, Amsler F, Iordache E et al (2021) Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on 3D reconstructed CT images. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06740-3CrossRefPubMedPubMedCentral

Hirschmann MT, Behrend H (2018) Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 26:2873–2874. https://doi.org/10.1007/s00167-018-4973-8CrossRefPubMed

Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB (2019) Phenotyping of hip–knee–ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 27:1378–1384. https://doi.org/10.1007/s00167-019-05507-1CrossRefPubMed

10.

Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S (2019) Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc 27:1385–1393. https://doi.org/10.1007/s00167-019-05508-0CrossRefPubMed

11.

Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27:1394–1402. https://doi.org/10.1007/s00167-019-05509-zCrossRefPubMed

12.

Ho JPY, Merican AM, Hashim MS, Abbas AA, Chan CK, Mohamad JA (2017) Three-dimensional computed tomography analysis of the posterior tibial slope in 100 knees. J Arthroplast 32:3176–3183. https://doi.org/10.1016/j.arth.2017.04.060CrossRef

13.

Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280. https://doi.org/10.1007/s00167-013-2621-xCrossRefPubMed

14.

Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthr Cartil 19:990–1002. https://doi.org/10.1016/j.joca.2011.05.004CrossRef

15.

Jenny JY, Baldairon F, Hirschmann MT (2021) Functional knee phenotypes of OA patients undergoing total knee arthroplasty are significantly more varus or valgus than in a non-OA control group. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06687-5CrossRefPubMed

16.

Ji HM, Han J, Jin DS, Seo H, Won YY (2016) Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24:2436–2441. https://doi.org/10.1007/s00167-016-3995-3CrossRefPubMed

17.

Kawahara S, Mawatari T, Matsui G, Mizu-Uchi H, Hamai S, Akasaki Y et al (2021) Malrotation of whole-leg radiograph less than 10 degrees does not influence preoperative planning in open-wedge high tibial osteotomy. J Orthop Res 39:1505–1511. https://doi.org/10.1002/jor.24845CrossRefPubMed

18.

Kawakami H, Sugano N, Yonenobu K, Yoshikawa H, Ochi T, Hattori A et al (2004) Effects of rotation on measurement of lower limb alignment for knee osteotomy. J Orthop Res 22:1248–1253. https://doi.org/10.1016/j.orthres.2004.03.016CrossRefPubMed

19.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494CrossRefPubMedPubMedCentral

20.

Lankester BJ, Cottam HL, Pinskerova V, Eldridge JD, Freeman MA (2008) Variation in the anatomy of the tibial plateau: a possible factor in the development of anteromedial osteoarthritis of the knee. J Bone Jt Surg Br 90:330–333. https://doi.org/10.1302/0301-620X.90B3.19898CrossRef

21.

Lee YS, Howell SM, Won YY, Lee OS, Lee SH, Vahedi H et al (2017) Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3467–3479. https://doi.org/10.1007/s00167-017-4558-yCrossRefPubMed

22.

León-Muñoz VJ, López-López M, Martínez-Martínez F, Santonja-Medina F (2020) Comparison of weight-bearing full-length radiographs and computed-tomography-scan-based three-dimensional models in the assessment of knee joint coronal alignment. Knee 27:543–551. https://doi.org/10.1016/j.knee.2019.11.017CrossRefPubMed

23.

Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24:570–578. https://doi.org/10.1016/j.arth.2008.03.002CrossRef

24.

MacDessi SJ, Griffiths-Jones W, Chen DB, Griffiths-Jones S, Wood JA, Diwan AD et al (2020) Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial. Bone Jt J 102-b:117–124. https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0674.R2CrossRef

25.

MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2020) The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee: a matched-pairs radiographic study. Bone Jt Open 1:339–345. https://doi.org/10.1302/2633-1462.17.BJO-2020-0037.R1CrossRefPubMedPubMedCentral

26.

McEwen P, Balendra G, Doma K (2019) Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty. Bone Jt J 101-b:331–339. https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-0544.R1CrossRef

27.

McEwen PJ, Dlaska CE, Jovanovic IA, Doma K, Brandon BJ (2020) Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery. J Arthroplast 35:443–450. https://doi.org/10.1016/j.arth.2019.08.064CrossRef

28.

Meier M, Janssen D, Koeck FX, Thienpont E, Beckmann J, Best R (2021) Variations in medial and lateral slope and medial proximal tibial angle. Knee Surg Sports Traumatol Arthrosc 29:939–946. https://doi.org/10.1007/s00167-020-06052-yCrossRefPubMed

29.

Moser LB, Hess S, Amsler F, Behrend H, Hirschmann MT (2019) Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:1359–1367. https://doi.org/10.1007/s00167-019-05417-2CrossRefPubMed

30.

Nakagawa S, Arai Y, Inoue H, Fujii Y, Kaihara K, Mikami Y (2020) Relationship of alignment in the lower extremity with early degeneration of articular cartilage after resection of the medial meniscus: quantitative analysis using T2 mapping. Medicine (Baltim) 99:e22984. https://doi.org/10.1097/MD.0000000000022984CrossRef

31.

Ogawa H, Matsumoto K, Akiyama H (2018) Coronal tibiofemoral subluxation is correlated to correction angle in medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 26:3482–3490. https://doi.org/10.1007/s00167-018-4948-9CrossRefPubMed

32.

Ogawa H, Matsumoto K, Akiyama H (2019) Effect of increased posterior tibial slope on the anterior cruciate ligament status in medial open wedge high tibial osteotomy in an uninjured ACL population. Orthop Traumatol Surg Res 105:1085–1091. https://doi.org/10.1016/j.otsr.2019.05.003CrossRefPubMed

33.

Rivière C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J (2018) Kinematic alignment technique for total hip and knee arthroplasty: the personalized implant positioning surgery. EFORT Open Rev 3:98–105. https://doi.org/10.1302/2058-5241.3.170022CrossRefPubMedPubMedCentral

34.

Seidenstein A, Birmingham M, Foran J, Ogden S (2021) Better accuracy and reproducibility of a new robotically-assisted system for total knee arthroplasty compared to conventional instrumentation: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 29:859–866. https://doi.org/10.1007/s00167-020-06038-wCrossRefPubMed

35.

Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21:2325–2330. https://doi.org/10.1007/s00167-013-2481-4CrossRefPubMed

36.

Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD (2016) The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Jt J 98-b:1360–1368. https://doi.org/10.1302/0301-620X.98B10.36862CrossRef

37.

White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Jt Surg Br 73:582–586. https://doi.org/10.1302/0301-620X.73B4.2071640CrossRef

38.

Yoon JR, Lee JK, Ryu J, Um R, Yang JH (2021) Increased external rotation of the osteoarthritic knee joint according to the genu varum deformity. Knee Surg Sports Traumatol Arthrosc 29:1098–1105. https://doi.org/10.1007/s00167-020-06100-7CrossRefPubMed

Titel: Medial proximal tibial angle at the posterior tibial plateau represents the pre-arthritic constitutional medial proximal tibial angle in anterior cruciate ligament-intact, advanced osteoarthritis of the knee
verfasst von: Hiroyasu Ogawa
Yutaka Nakamura
Masaya Sengoku
Tetsuya Shimokawa
Kazuki Sohmiya
Kazuichiro Ohnishi
Kazu Matsumoto
Haruhiko Akiyama
Publikationsdatum: 27.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 9/2022
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-022-06890-y

The importance of joint line obliquity: a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty

KNEE

No difference in patient-reported satisfaction after 12 months between customised individually made and off-the-shelf total knee arthroplasty

Open Access
KNEE

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

KNEE

Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre

Open Access
KNEE

The rebirth of computer-assisted surgery. Precise prosthetic implantation should be considered when targeting individualized alignment goals in total knee arthroplasty

Editorial

No differences in 10-year clinical outcomes and quality of life between patients with different mediolateral femoral component positions in fixed-bearing medial unicompartmental knee arthroplasty

KNEE

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Was sich Menschen mit Frozen Shoulder wünschen

10.01.2025
Schultersteife
Nachrichten

Die Capsulitis adhaesiva des Glenohumeralgelenks, auch als Frozen Shoulder bezeichnet, belastet die Betroffenen weit über die körperlichen Beschwerden hinaus, wie eine italienische Studie ergeben hat.

Restriktive Sauerstoffgabe ohne Vorteil bei schwerem Trauma

09.01.2025
Traumatologische Notfallmedizin
Nachrichten

Ob schwer verletzte Personen besser restriktiv oder liberal mit Sauerstoff versorgt werden sollten, hat die Arbeitsgruppe der TRAUMOX2-Studie untersucht – mit klarem Ergebnis.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Medial proximal tibial angle at the posterior tibial plateau represents the pre-arthritic constitutional medial proximal tibial angle in anterior cruciate ligament-intact, advanced osteoarthritis of the knee