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Revisiting the tibial crest as reference for the mechanical alignment of the tibial component in total knee arthroplasty: a cadaveric study on Caucasian tibiae.

Authors
  • Cinotti, Gianluca1
  • Ripani, Francesca Romana2
  • Sinno, Ennio2
  • Sarti, Sara2
  • LaTorre, Giuseppe3
  • Giannicola, Giuseppe2
  • 1 Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University "La Sapienza", Piazzale Aldo Moro, 5, 00185, Rome, Italy. [email protected] , (Italy)
  • 2 Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University "La Sapienza", Piazzale Aldo Moro, 5, 00185, Rome, Italy. , (Italy)
  • 3 Department of Public Health and Infectious Diseases, University "La Sapienza", Piazzale Aldo Moro, 5, 00185, Rome, Italy. , (Italy)
Type
Published Article
Journal
Musculoskeletal surgery
Publication Date
Jan 30, 2020
Identifiers
DOI: 10.1007/s12306-020-00639-x
PMID: 32002790
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The accuracy of the tibial crest (TC) in guiding the mechanical alignment of the tibial component in total knee arthroplasty (TKA) has been investigated in a few studies on Asian patients. No study analyzed the anatomical variants of the TC. We analyzed the morphological types of the TC in cadaveric tibiae of Caucasian subjects and assessed whether the TC may be considered an accurate guide for the mechanical alignment of the tibial component in TKA. The TC and mechanical axis (MA) were identified in 86 dried cadaveric tibiae by placing metal landmarks along the TC course and a guidewire overlapping the MA. Coronal view radiographs were taken in different positions of tibial axial rotation, and the relationships between the TC and MA were analyzed. The TC showed three different patterns, comprising a curved, mixed and straight course in 47 (54.6%), 21 (24.4%) and 18 (20.9%) tibiae, respectively. When a curved course was found, the TC intersected the MA at proximal and distal points located, on average 22.4% and 63.3% along the tibial length, respectively. When a straight course was found, the mean angle between the TC and MA was 2.9°. In 35% of the cases, the two axes differed by more than 3°. The TC of Caucasian subjects exhibits a marked variability in its course and relationship with the MA. Unlike the TC in Asian subjects, the TC of Caucasians cannot be considered an accurate anatomical reference to guide the coronal alignment of the tibial component in TKA.

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