Extensor hallucis longus tendon is a new distal landmark for coronal tibial component alignment in total knee arthroplasty: A study of magnetic resonance imaging

Efficacy Analysis of Selection of Distal Reference Point for Tibial Coronal Plane Osteotomy during Total Knee Arthroplasty: A Literature Review

Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis. The tibial platform osteotomy must take full account of the coronal plane, the sagittal plane, and the rotational alignment of the tibial prosthesis. During surgery, individual differences in the coronal alignment of the tibia need to be taken into account as poor alignment after surgery can lead to rapid wear of the tibial platform, reducing the longevity of the prosthesis and adversely affecting quality of life. Intraoperative tibial osteotomies are often performed using extramedullary alignment. When an extramedullary alignment approach is used, the proximal tibial osteotomy guide is usually placed in the medial third of the tibial tuberosity. There is no consensus on the most reliable anatomical landmarks or axes for achieving distal tibial coronary alignment. Anatomical points or reference axes that are highly reproducible and precise need to be identified. From available data it appears that most surgeons use the extensor hallucis longus tendon, the second metatarsal, and the anterior tibial cortex to determine the distal localization point. However, its accuracy has not been confirmed in clinical and radiographic data, and the alignment concept and preoperative planning for total knee arthroplasty has paid more attention to rotational alignment, but there are few studies on the coronal alignment of the tibia. This article reviews the recent use of the distal tibial coronal osteotomy reference point in total knee arthroplasty. However, due to there being only a small number of studies available, the evidence collected is insufficient to prove that a certain reference axis has obvious advantages and a combination of different reference points is needed to achieve the ideal lower extremity force line angle.