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Perelli S, Costa GG, Russo A, Hinarejos P, Torres-Claramunt R, Sanchez-Soler J, Morales-Avalos R, Monllau JC. The distal tibiofibular syndesmosis is a reliable landmark for 3° varus tibial resection in total knee arthroplasty: a radiological evaluation on 1296 cases. Arch Orthop Trauma Surg 2024; 144:879-885. [PMID: 37864591 DOI: 10.1007/s00402-023-05099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/30/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the reproducibility and the accuracy of distal tibiofibular syndesmosis (DTFS) as landmark to perform controlled varus tibial resections during total knee arthroplasty (TKA). The hypothesis was that DTFS can be used to perform an accurate 3° varus tibial cut. METHODS A retrospective analysis on a consecutive series of standard weightbearing full-length anteroposterior views of the lower limbs radiographic images was conducted. For each radiograph, the hip-knee-ankle (HKA) angle, the angle between the tibial mechanical axis and the line connecting the centre of the tibial spines and the DTFS (tibiofibular angle, TFA) and the medial proximal tibial angle (MPTA) were calculated. Each measurement was carried out twice by three independent observers, and intra- and inter-observer measurement reliability were assessed using the intraclass correlation coefficient (ICC) analysis. RESULTS A total of 1296 lower limbs were analysed from a series of 648 weightbearing full-length anteroposterior radiographs. The ICC were > 90% for all measurements. The mean TFA value was 2.94 ± 0.68 (range 2.38-3.51). No differences were detected comparing the mean TFA value on the right and left limb (p = 0.795) as well as comparing the values in male and female patients (p = 0.691). Linear regression analysis did not find statistically significant correlation between TFA and MPTA, or TFA and HKA angles, respectively. CONCLUSION The distal tibiofibular syndesmosis is a reliable and easy reproducible radiographic landmark that can be used when planning a 3° varus tibial cut. Future studies are needed to confirm the validity of this method also in clinical settings. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Simone Perelli
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Giuseppe Gianluca Costa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy.
| | - Arcangelo Russo
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy
| | - Pedro Hinarejos
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Raul Torres-Claramunt
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Juan Sanchez-Soler
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Rodolfo Morales-Avalos
- Knee Unit, Department of Orthopedic Surgery and Traumatology, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
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Zhang G, Liu M, Fan S, Liu Z, Nie X, Qi X, Yang C. Comparison of the femoral condylar ellipse line and the surgical epicondylar axis: 3D measurement by MRI scans in healthy Chinese people. Orthop Surg 2023. [PMID: 37317056 PMCID: PMC10350392 DOI: 10.1111/os.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE The sagittal shapes of the femoral condyles were thought to consist of circles. However, the line connecting the centers of circles was not consistent with the surgical epicondylar axis (SEA) which was commonly used in surgery. Recently, ellipses have been proposed as an alternative method to represent the sagittal femoral condylar shape. Does the condylar ellipse line (CEL) coincide with the SEA in 3D MRI reconstruction analysis? METHODS From May to August 2021, a total of 80 healthy subjects were scanned by MRI on the right knee in this retrospective study. The ellipses on the most distal slices of the medial and lateral condyles were determined. A line connecting the centers of the medial and lateral ellipses was the CEL. A line connecting the deepest point of the medial sulcus and the most prominent point of the lateral epicondyle was the SEA. Angular measurement of the SEA and the CEL relative to the posterior condylar line (PCL) and the distal condylar line (DCL) was performed on an axial and coronal view of the 3D model, respectively. Measurements were compared between males and females by using the independent-samples t-test. Pearson correlation was used to analyze the relationship between SEA-PCL and CEL-PCL, SEA-DCL, and CEL-DCL. RESULTS On the axial view, the mean SEA-CEL was 0.35° ± 0.96°. SEA-PCL (2.91° ± 1.40°) had a high correlation with CEL-PCL (3.27° ± 1.11°) (r = 0.731, p < 0.001). On the coronal view, the mean coronal SEA-CEL was 1.35° ± 1.13°. SEA-DCL (1.35° ± 1.13°) had a low correlation with CEL-DCL (0.18° ± 0.84°) (r = 0.319, p = 0.007). On the sagittal view, the outlet points of the CEL on the medial and lateral epicondyles were anatomically located in the anteroinferior direction to the SEA. CONCLUSIONS CEL traversed the medial and lateral epicondyles, which has a mean deviation of 0.35° with SEA on axial view and a mean deviation of 0.18° with DCL on coronal view. This study suggested that the ellipse approach is an improved scheme for representing the femoral condylar shape.
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Affiliation(s)
- Guanpeng Zhang
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
- Department of Orthopaedic Surgery 3nd, Xuchang Central Hospital, Xuchang, China
| | - Mingyang Liu
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
- Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Shenghu Fan
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Zhaoliang Liu
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xinlin Nie
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xin Qi
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Chen Yang
- Department of Orthopaedic Surgery Center, The First Hospital of Jilin University, Changchun, China
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Xu X, Yang J, Li J, Yao D, Deng P, Chen B, Liu Y. Relationship between the height of fibular head and the incidence and severity of knee osteoarthritis. Open Med (Wars) 2022; 17:1330-1337. [PMID: 35937003 PMCID: PMC9307141 DOI: 10.1515/med-2022-0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the correlation between fibular head height and the incidence and severity of osteoarthritis associated with varus knee deformity. The fibular head height, joint line convergence angle (JLCA) and medial proximal tibial angle (MPTA) were measured in a three-dimensional model. Ordinal multivariate logistic regression was used to analyze the correlation between fibular head height and Kellgren–Lawrence (K–L) grade. Pearson correlation was used to analyze the correlation between fibular head height and K–L grade. A total of 232 patients (232 knees) were finally included in the study. There were significant differences in JLCA and hip–knee–ankle angle (P < 0.05), and both JLCA and hip–knee–ankle angle increased with severe aggravation of K–L grade. Both fibular head height and MPTA decreased as the K–L grade was severely aggravated. There was a significant negative correlation between K–L grade and fibular head height (r = −0.812, P < 0.001). Furthermore, there was a significant negative correlation between fibular head height and hip–knee–ankle angle (r = −0.7905, P < 0.001). In addition to body mass index, fibular head height is a risk factor for the pathogenesis of osteoarthritis associated with varus knee deformity; the smaller the fibular head height, the more severe the degree of varus deformity.
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Affiliation(s)
- Xinghui Xu
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Jin Yang
- Department of Traumatology, Orthopedics Hospital, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine , Shaanxi , China
| | - Jun Li
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Deping Yao
- Department of Radiology, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Pan Deng
- Department of Joint Orthopaedic, The First Clinical Medical College, Guangzhou University of Chinese Medicine , Guangzhou , Guangdong 510405 , China
| | - Boliang Chen
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Yifei Liu
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
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Jin Y, Li P, Yang Y, Zeng X, Shen H, Zhang L, Tsai TY, Chen J. A New Reference Axis for Tibial Component Rotation in Total Knee Arthroplasty: A Three-dimensional Computed Tomography Analysis. Front Surg 2022; 9:872533. [PMID: 35574544 PMCID: PMC9091956 DOI: 10.3389/fsurg.2022.872533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to introduce a new reference axis for tibial rotation in total knee arthroplasty (TKA) and verify its reliability. A consecutive series of 80 knees that underwent TKA from 2018 to 2020 as well as 80 healthy knees were analyzed using a three-dimensional tibial model. A coordinate system was established based on the standard TKA tibial cut. The line connecting the lateral-tibial eminence and the medial 1/3rd of the tibial tubercle or the medial border of the tibial tubercle was identified as the lateral eminence line (LE line) and the medial lateral eminence line (MLE line), respectively. To evaluate the reliability of the new reference axis, Akagi's line, the medial third of the tibial tubercle (1/3 line) was compared with the LE and MLE lines by measuring the angle between the lines and the Z-axis. In the coronal view, the intersection angle (TPA), which is composed of the line connecting the center of the medial and lateral tibial plateau with the Z-axis, was measured. The mean angle between Akagi's line and the Z-axis in the healthy group and the osteoarthritis (OA) group was 87.57 ± 3.48° and 87.61 ± 3.47°, respectively. The mean angle between the LE line and Z-axis in the healthy and OA groups was 87.15 ± 4.13° and 86.78 ± 3.95°, respectively. A weak correlation was found between the TPA and Akagi's line and the 1/3 line. A moderate correlation was observed between the TPA and LE lines. There were no significant differences between the healthy and OA groups (P > 0.05) in any of the four reference axes. The LE line showed excellent intra- and inter-observer reliability and reproducibility. The novel and easily drawn LE line is a preferable option for tibial component rotational alignment in TKA.
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Affiliation(s)
- Yan Jin
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Pingyue Li
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Pingyue Li
| | - Yiming Yang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xianli Zeng
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lihang Zhang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education, Beijing, China
| | - Jiarong Chen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Liu MY, Li HJ, Yang C, Zang WD, Liu ZD, Zhang L, Li PH, Zhu YJ, Zhao YY, Liu RZ, Gao YZ. Insight into the pharmacological effects of andrographolide in musculoskeletal disorders. Biomed Pharmacother 2021; 146:112583. [PMID: 34954644 DOI: 10.1016/j.biopha.2021.112583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Andrographis paniculata (A. paniculata) is a traditional herbal medicine that has been widely used in Asian countries for hundreds of years. Andrographolide (AG) is a diterpene lactone extracted from A. paniculata. Owing to the in-depth study of pharmacological mechanisms, the therapeutic potential of AG, including its anti-inflammatory, anti-tumor, and immunoregulatory attributes, has attracted the attention of many researchers. Studies testing the therapeutic effects of AG have demonstrated desirable results in the treatment of a variety of clinical diseases. With high safety and various biological functions, AG might be a promising candidate for the treatment of musculoskeletal disorders. Here, we review all available literatures to summarize the pharmacological effects of AG and facilitate further researches on musculoskeletal diseases.
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Popescu R, Cristea S, Oleksik V, Pascu AM, Haritinian EG. Finite element analysis of the tibial component alignment in a transverse plane in total knee arthroplasty. J Appl Biomed 2021; 19:234-239. [PMID: 34907743 DOI: 10.32725/jab.2021.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
The research aims to analyze the tibial component rotation using the finite element method by resecting the tibia in a transverse plane at an angle between 1.5° (external rotation) and -1.5° (internal rotation). We used a three-dimensional scanner to obtain the tibia's geometrical model of a cadaveric specimen. We then exported the surfaces of the tibial geometrical model through the Computer-Aided Three-dimensional Interactive Application (CATIA), which is a Computer-Aided Design (CAD) program. The CAD program three-dimensionally shaped the tibial component, polyethylene, and cement. Our analysis determined that the maximum equivalent stress is obtained in the case of proximal tibial resection at -1.5° angle in a transverse plane (internal rotation) with a value of 12.75 MPa, which is also obtained for the polyethylene (7.693 MPa) and cement (6.6 MPa). The results have shown that detrimental effects begin to occur at -1.5°. We propose the use of this finite element method to simulate the positioning of the tibial component at different tibial resection angles to appreciate the optimal rotation.
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Affiliation(s)
- Roman Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Cristea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Saint Pantelimon Emergency Hospital, Department of Orthopaedics and Traumatology, Bucharest, Romania
| | - Valentin Oleksik
- University of Sibiu, Faculty of Engineering, Department of Industrial Machinery and Equipments, Sibiu, Romania
| | - Adrian Marius Pascu
- University of Sibiu, Faculty of Engineering, Department of Industrial Machinery and Equipments, Sibiu, Romania
| | - Emil George Haritinian
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Hospital of Orthopaedics and Traumatology and Osteoarticular TB "Foisorr", Bucharest, Romania
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