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Cacciola G, Giustra F, Bosco F, Vezza D, Pirato F, Braconi L, Risitano S, Capella M, Massè A, Sabatini L. No significant clinical differences between native or reduced posterior tibial slope in kinematically aligned total knee replacement with posterior cruciate-retaining. J Orthop 2024; 54:32-37. [PMID: 38524363 PMCID: PMC10957378 DOI: 10.1016/j.jor.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Aims & objectives Total knee arthroplasty (TKA) is a common surgical procedure for end-stage knee osteoarthritis. However, conventional alignment techniques may lead to postoperative dissatisfaction in up to 20% of cases. Kinematic alignment (KA) has emerged as a new philosophy to restore the native joint line and achieve more natural kinematics. Preserving the posterior tibial slope (PTS) and posterior cruciate ligament (PCL) is crucial to maintaining the pre-arthritic joint line and improving knee kinematics. This study aimed to assess the prevalence of postoperative PTS changes and their impact on functional outcomes and range of motion. Materials & methods A retrospective single-center study was conducted on patients who underwent KA-TKA with PCL preservation. The preoperative and postoperative PTS were measured on lateral knee radiographs using the tibial proximal anatomic axis method. Patient-reported outcome measures (PROMs) were collected pre- and postoperatively up to a two-year follow-up. Results Of the 95 included patients, 62.1% achieved an anatomically similar PTS (within 3° from the preoperative value), while 37.9% experienced noticeable PTS changes. However, no significant associations existed between PTS changes and compromised PROMs (WOMAC, 22.2 and 23.1; FJS, 66.6 and 67.3), ROM (118.5° and 119.4°), or patient satisfaction. No postoperative complications requiring reoperation or component revisions were observed. Conclusion Preserving or modifying the native PTS during KA-TKA could be confidently undertaken without compromising functional outcomes or patient satisfaction.
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Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, San Giovanni Bosco Hospital—ASL Città di Torino, 10154, Turin, Italy
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Francesco Pirato
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Lorenzo Braconi
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Torino, Italy
| | - Luigi Sabatini
- Humanitas Gradenigo, Department of Robotic and Minimally-Invasive Arthroplasty Surgery, 10153, Turin, Italy
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Lee DW, Han HS, Ro DH. Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon) 2024; 114:106238. [PMID: 38599133 DOI: 10.1016/j.clinbiomech.2024.106238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND High tibial osteotomy is an established surgical option for medial compartment osteoarthritis of the knee with varus alignment. It can be divided into open wedge and closing wedge by operative technique. Although they have fundamental differences, little is known about the biomechanical consequences of the two surgical methods. METHODS Thirty-eight patients with medial compartment osteoarthritis who underwent high tibial osteotomy (19 open-wedge and 19 closing-wedge) were retrospectively reviewed. Clinical scores and radiological measurements were assessed until postoperative two years. Gait analysis was performed preoperatively and again at postoperative one year. FINDINGS Varus alignment was corrected in both groups without a significant difference between them (p = 0.543). However, posterior tibial slope was higher, and the Blackburne-Peel ratio was lower in the open wedge osteotomy group after surgery (both p < 0.001). Reduction of dynamic knee varus and knee adduction moment were observed in both groups without significant differences. However, after surgery, average knee range of motion (63.3° vs 57.3°, p < 0.001) and the magnitude of knee flexion moment was significantly lower (p = 0.005) in the closing wedge group. There were no significant differences in the Kujala Anterior Knee Pain Scale and the occurrence of patellofemoral arthritis between the groups postoperatively. INTERPRETATION After osteotomy, a smaller average knee range of motion in the sagittal plane and a higher knee flexion moment were observed in the open wedge osteotomy group, suggesting quadriceps muscle avoidance. However, no differences in clinical scores or the short-term occurrence of patellofemoral arthritis were noted between the two surgical techniques.
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Affiliation(s)
- Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hostpital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; CONNECTEVE Co., Ltd, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hostpital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, South Korea.
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Sun Y, Tang Y. The relationship between lateral femoral condyle ratio measured by MRI and anterior cruciate ligament injury. Front Bioeng Biotechnol 2024; 12:1362110. [PMID: 38600950 PMCID: PMC11004325 DOI: 10.3389/fbioe.2024.1362110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Background Previous studies have shown that the lateral femoral condyle ratio (LFCR) measured by X-ray has a significant relationship with the anterior cruciate ligament (ACL) injury. However, few relevant studies have been performed on LFCR measured by magnetic resonance imaging (MRI). Purpose (1) To evaluate the relationship between LFCR measured by MRI and ACL injury or rerupture. (2) To compare the LFCR measured by MRI with existing bony morphological risk factors and screen out the most predictive risk factors for primary ACL injury or rerupture. Study Design Cohort study; Level of evidence, 3. Methods Totally 147 patients who underwent knee arthroscopic surgery from 2015 to 2019 with minimum follow-up of 48 months were retrospectively evaluated. Patients were placed into three groups: 1) the control group of patients with simple meniscus tears without ligament injury; 2) the primary noncontact ACL injury group; 3) ACL rerupture group (ACL reconstruction failure). The LFCR measured by MRI and other previous known risk factors associated with MRI (notch width index, medial tibial slope, lateral tibial slope, medial tibial depth, lateral tibial height) were performed to evaluate their predictive value for ACL injury and rerupture. All the risk factors with p < 0.01 according to univariate analysis were included in the logistic regression models. Receiver operating characteristic (ROC) curves were analyzed for sensitivity, specificity, cut-off, and area under the curve (AUC). Z tests were used to compare the AUC values. Results The LFCR measured by MRI was obviously higher in primary ACL injury group (0.628 ± 0.020) and in ACL rerupture group (0.625 ± 0.021) than that in the control group (0.593 ± 0.030). The best risk factor was the LFCR with a cut-off of 0.602 (AUC, 0.818; 95% CI, 0.748-0.878; sensitivity, 90%; specificity, 66%). When combined with lateral tibial slope (cutoff, 7°) and lateral tibial height (cutoff, 3.6 mm), the diagnostic performance was improved significantly (AUC, 0.896; 95% CI, 0.890-0.950; sensitivity, 87%; specificity, 80%). Conclusion The increased LFCR measured by MRI was associated with a significantly higher risk for ACL injury or rerupture. The combination of LFCR, lateral tibial slope and lateral tibial height were the most predictive risk factors. This may help clinicians identify susceptible individuals and allow precision approaches for better prevention, treatment and management of this disease.
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Affiliation(s)
- Yang Sun
- Department of Sports Medicine, The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Yun Tang
- Department of Sports Medicine, The First People’s Hospital of Lianyungang, Lianyungang, China
- Clinical Research Center, The First People’s Hospital of Lianyungang, Lianyungang, China
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Lee SH, Yoo JH, Kwak DK, Kim SH, Chae SK, Moon HS. The posterior tibial slope affects the measurement reliability regarding the radiographic parameter of the knee. BMC Musculoskelet Disord 2024; 25:202. [PMID: 38454368 PMCID: PMC10918909 DOI: 10.1186/s12891-024-07330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Posterior tibial slope (PTS) exhibits considerable variability among individuals and is anticipated to influence the accuracy of radiographic measurements related to the knee. Despite this potential impact, there is a lack of prior research investigating how PTS affects the accuracy of these measurements. Therefore, this study aimed to investigate the effect of PTS on the measurement reliability regarding the radiographic parameter of the knee. METHODS The medical records of patients who took full-length anteroposterior radiographs of the lower limb between January 2020 and June 2022 were evaluated retrospectively. Radiographic parameters related to the knee joint characteristics such as osteoarthritis grade, hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle (MPTA), lateral distal femoral angle, joint-line convergence angle (JLCA), and PTS were measured. Subjects were classified into 3 groups according to PTS (group A, PTS < 4°; group B, PTS ≥ 4° and < 8°; group C, PTS ≥ 8°), and the measurement reliability for the radiographic variables was compared between groups. The intra- and inter-observer agreements were assessed using the kappa coefficients, intra-class correlation coefficients (ICC), and Bland-Altman plots. RESULTS A total of 175 limbs (86 patients) were included in this study. As the intra- and inter-observer reliability for PTS ranged over 0.9, grouping was performed based on the average of the measured PTSs. The inter-observer reliability of the MPTA and JLCA decreased as the PTS increased (ICCs for MPTA in Groups A, B, and C: 0.889, 0.796, and 0.790, respectively; ICCs for JLCA in Groups A, B and C: 0.916, 0.859, and 0.843, respectively), whereas there were no remarkable differences in other variables. Similar trends were observed in the comparisons of intra-observer reliability and Bland-Altman plots also showed consistent results. CONCLUSION The larger the PTS, the lower the measurement reliability regarding the radiographic parameters of the knee that includes the joint line, such as MPTA and JLCA. Given the occasional challenge in accurately identifying the knee joint line in patients with a relatively large PTS, careful measurement of radiographic parameters is crucial and utilizing repetitive measurements for verification may contribute to minimizing measurement errors.
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Affiliation(s)
- Seung-Hun Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Je-Hyun Yoo
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Dae-Kyung Kwak
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Kuk Chae
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyun-Soo Moon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Koh JH, Lim S, Park JY, Chung JY, Jin YJ, Yun HW, Noh S, Park DY. Controlled posterior condylar milling technique for unicompartmental knee arthroplasty minimises tibia resection during gap balancing: Short-term clinical results. Knee Surg Sports Traumatol Arthrosc 2024; 32:499-508. [PMID: 38240064 DOI: 10.1002/ksa.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE The purpose of this study was to demonstrate the clinical utility of controlled posterior condylar milling (CPCM) in gap balancing while minimally resecting the tibia during fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This study is a retrospective cohort study. Patients who underwent medial UKA for isolated medial compartment osteoarthritis with a minimum follow-up of 2 years were included. The patients were divided into two groups: the conventional group (n = 56) and the CPCM group (n = 66). In the CPCM group, the proximal tibia was resected at the level of the distal end of the subchondral bone. If the flexion gap was tighter than extension, the posterior condyle was additionally milled to adjust gap tightness. Standing knee X-ray and scanogram were used to evaluate alignment and tibia resection amount. Range of motion (ROM) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were used to evaluate clinical outcomes. RESULTS The CPCM group showed significantly smaller tibia resection (3.6 ± 1.9 mm) compared to the conventional group (5.2 ± 2.7 mm) (p < 0.001). Postoperative ROM (133.0 ± 8.3°, 135.2 ± 7.2°, n.s.) and WOMAC (19.3 ± 13.6, 23.6 ± 17.7, n.s.) were not significantly different between the two groups. Postoperative periprosthetic fractures occurred in two patients in conventional group, while the CPCM group had no periprosthetic fractures. CONCLUSION The CPCM technique may be a simple and useful intraoperative technique that can achieve minimal tibia resection and promising clinical outcomes while easily adjusting gap tightness between flexion and extension during medial fixed-bearing UKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeong-Hyun Koh
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Sumin Lim
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Yong Jun Jin
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Hee-Woong Yun
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Sujin Noh
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Do Young Park
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
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Kavak S, Kaya S. Evaluation of the relationship of posterior tibial slope with gender and age in Turkish population with 3 different methods. BMC Musculoskelet Disord 2024; 25:102. [PMID: 38291387 PMCID: PMC10826083 DOI: 10.1186/s12891-024-07209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND This study aimed to reveal the posterior tibial slope (PTS) angle with 3 different methods in a large case group in the Turkish population. In addition, the reproducibility of the measurement methods used was questioned while determining the age groups, gender and side relationship of this angle. MATERIALS AND METHODS In our retrospective study, radiographs of both knees were evaluated in all 610 patients (344 women, 56.4%) aged 25-65 years. PTS angles were measured by a radiologist and an orthopedist using anterior tibial cortex (ATC), posterior tibial cortex (PTC) and proximal tibial anatomical axis (PTAA) methods. The relationship of these angles with age group and gender, and the intra-class and inter-class correlations of all three methods were evaluated. RESULTS The mean and standard deviation (SD) of PTS angle was 11.03 ± 2.33° with ATC method, 6.25 ± 2.22° with PTC and 8.68 ± 2.16° with PTAA, and the difference was significant (p < .001). In the evaluation according to age groups, the highest mean PTS angles were detected in cases aged 25-35 (9.63 ± 1.97° [mean ± SD] by PTAA method), and there was a significant difference in comparison with other age groups (p < .05). In comparison with age groups, higher mean PTS angles were found in women and on the right side, but the difference was not statistically significant (p > .05). The intraclass and interclass correlation coefficient (ICC) of all three methods was excellent (ICC > 0.91). CONCLUSION This study emphasizes that the mean PTS angle in Turkish population is higher than the angle values recommended by prosthesis manufacturers, and factors such as patient age and gender should be calculated in order to ensure more effective prostheses to be applied to patients.
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Affiliation(s)
- Seyhmus Kavak
- Department of Radiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Elazig Road, 10th km Uçkuyular Location, Kayapınar, Diyarbakir, 21070, Turkey.
| | - Sehmuz Kaya
- Dursun Odabaşı Medicine Center, Department of Orthopedics and Traumatology, University of Yüzüncü Yıl, Van, Turkey
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Nedaie S, Vivekanantha P, O'Hara K, Slawaska-Eng D, Cohen D, Abouali J, Hoshino Y, Nagai K, Johnson J, de Sa D. Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:167-180. [PMID: 38226729 DOI: 10.1002/ksa.12025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction. METHODS Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded. RESULTS Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries. CONCLUSION Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kaylin O'Hara
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Dan Cohen
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Jihad Abouali
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jansen Johnson
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Darren de Sa
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
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Akçaalan S, Akkaya M, Dogan M, Valdivielso AA, Zeiton MA, Mohammad HR, Sangaletti R, Benazzo F, Kara S, Gehrke T, Citak M. Do age, gender, and region affect tibial slope? A multi-center study. Arch Orthop Trauma Surg 2023; 143:6983-6991. [PMID: 37438581 DOI: 10.1007/s00402-023-04976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. MATERIALS AND METHODS A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60-69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. RESULTS The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. CONCLUSIONS Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope.
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Affiliation(s)
- Serhat Akçaalan
- Orthopedics and Traumatology Clinics, Kirikkale Yuksek Ihtısas Hospital, Bağlarbaşı, Ahmet Ay Caddesi, 71300, Merkez/Kırıkkale, Turkey.
| | - Mustafa Akkaya
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Metin Dogan
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Ainhoa Alvarez Valdivielso
- Orthopaedic Surgery and Traumatology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Moez Asaid Zeiton
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Hasan Raza Mohammad
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- IUSS, Istituto di Studi Superiori, Pavia, Italy
| | - Seher Kara
- Helios ENDO-Klinik, Holstenstr, Hamburg, Germany
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Akcaalan S, Kavaklilar A, Caglar C, Ugurlu M, Dogan M, Akkaya M. Investigation of Morphometric Factors Associated With Adolescent ACL Rupture. Orthop J Sports Med 2023; 11:23259671231194928. [PMID: 37693804 PMCID: PMC10492494 DOI: 10.1177/23259671231194928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background There are no definitive anatomic morphometric risk factors for adolescent anterior cruciate ligament (ACL) injury. Purpose To compare the parameters used to define the tibial and femoral morphometric structure of the knee between adolescent patients with and without ACL rupture. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were magnetic resonance imaging (MRI) scans and radiographs of 115 patients aged 10 to 17 years who were evaluated for ACL rupture at a single institution between February 1, 2019, and January 31, 2022. Images from 115 patients with intact MRI scans were included as controls. We investigated the following imaging parameters: tibial slope (on lateral radiograph), lateral condylar height, tibial sulcus height, medial condylar height, condylar width, intercondylar notch with, intercondylar notch angle, notch index, eminence width, tibial plateau width, eminence width/tibial plateau width, medial/lateral/overall eminence height, medial plateau depth, and 2 different eminence angles. Parameters were compared between groups using the chi-square, Fisher exact, Student t, or Mann-Whitney U test, as appropriate. Receiver operating characteristic analysis was conducted for cutoff values of significant parameters. Results There were no significant differences in age, sex, or side affected between groups. Only the medial plateau depth was found to be statistically significant between the ACL rupture and ACL intact groups (2.6 vs 2.2 mm; P = .015). A statistically significant cutoff value could not be obtained for the medial plateau depth. Conclusion Medial plateau depth was found to be significantly greater in adolescent patients with ACL rupture compared with ACL-intact controls.
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Affiliation(s)
- Serhat Akcaalan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | | | - Ceyhun Caglar
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Mahmut Ugurlu
- Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Metin Dogan
- Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Mustafa Akkaya
- Yildirim Beyazit University School of Medicine, Ankara, Turkey
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Feng K, Wang T, Tang J, Hao X, Ma X, Qu Z, Wang W. Application of CT-MRI Fusion-Based Three-Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament. Orthop Surg 2022; 14:2845-2853. [PMID: 36120826 PMCID: PMC9627086 DOI: 10.1111/os.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
Objective During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient‐specific anatomical data, we established a three‐dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction. Methods This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three‐dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t‐tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant. Results All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1‐LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1‐LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne‐glass drop‐off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment‐related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm2, respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm2, respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas. Conclusion In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.
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Affiliation(s)
- Keyi Feng
- Department of Bone and Joint Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tianyue Wang
- Department of Maxillofacial Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Jin Tang
- Department of Bone and Joint Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Xiaorui Hao
- Department of Orthopaedics, Nanping First Hospital affiliated to Fujian Medical University, Nanping, China
| | - Xiaojun Ma
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zhenan Qu
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Weiming Wang
- Deportment of Sports Medicine, Affiliated Xinhua Hospital of Dalian University, Dalian, China
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