Coronal Alignment Of Lower Limb Research Articles

Coronal Knee Alignment and Tibial Rotation in Total Knee Arthroplasty: A Prospective Cohort Study of Patients with End-Stage Osteoarthritis.

Several studies have found a relationship between the rotational anatomy of the distal femur and the overall coronal lower limb alignment in knees with osteoarthritis (OA). Less is known about the rotation of the proximal tibia, especially in the context of total knee arthroplasty (TKA), where one of the goals of the surgery is to achieve the appropriate component-to-component rotation. The aim of this study was to investigate the relationship between the coronal alignment of the lower extremity and the relative proximal tibial rotation. A prospective cohort study of patients with an end-stage OA scheduled for TKA was conducted. All patients underwent a computed tomography (CT) scan and a standing X-ray of both lower limbs. A relative femorotibial rotation was measured separately for mechanical and kinematic alignment. A statistically significant correlation was found between the tibial varus and the external tibial rotation (p < 0.001). Out of 14 knees with high tibial varus (>5°), 13 (93%) and 7 (50%) knees had >10° of femorotibial rotation for the mechanical and kinematic alignment landmarks, respectively. In order to keep the component-to-component rotation within the 10° margin, more internal rotation of the tibial component is required in knees with higher tibial varus.

The learning curve of imageless robot-assisted total knee arthroplasty with standardised laxity testing requires the completion of nine cases, but does not reach time neutrality compared to conventional surgery.

The assistance of robot technology is introduced into the operating theatre to improve the precision of a total knee arthroplasty. However, as with all new technology, new technology requires a learning curve to reach adequate proficiency. The primary aim of this study was to identify the learning curve of an imageless robotic system with standardised laxity testing. The secondary aim of this study was to evaluate the accuracy of the intra-operative coronal alignment during the learning curve. A prospective study was performed on 30 patients undergoing robot-assisted total knee arthroplasty with an imageless robotic system (Corin, Massachusetts, USA) associated with a dedicated standardised laxity testing device. The learning curve of all surgical steps was assessed with intra-operative video monitoring. As comparison, the total surgical time of the last 30 patients receiving conventional total knee arthroplasty by the same surgeon and with the same implant was retrospectively assessed. Coronal lower limb alignment was evaluated pre- and post-operatively on standing full-leg radiographs. CUSUM (cumulative summation) analysis has shown inflexion points in multiple steps associated with robot-assisted surgery between one and 16 cases, which indicates the progression from the learning phase to the proficiency phase. The inflexion point for total operative time occurred after nine cases. Robot-assisted total knee surgery required significantly longer operative times than the conventional counterpart, with an average increase of 22min. Post-operative limb and implant alignment was not influenced by a learning curve. The introduction of an imageless robotic system with standardised laxity assessment for total knee arthroplasty results in a learning curve of nine cases based on operative time. Compared to conventional surgery, the surgeon is not able to reach time neutrality with the robotic platform. There is no learning curve associated with coronal limb or implant alignment. This study enables orthopaedic surgeons to understand the implementation of this surgical system and its specific workflow into clinical practice.

A New Radiographic Method for Estimating Tibial Malrotation

Background: Diaphyseal tibial fractures are the most frequent bone fractures in the body and are usually treated with intramedullary nailing method. However, this approach is responsible for 41% of the rotational deviation. Objectives: This study aimed to provide a radiographic evaluation method to determine tibial malrotation in closed fixation of tibia bone fractures during or after the operation. Methods: This study was conducted in a university hospital from May 2015 to March 2016. All patients referring to the hospital with the complaints of minor trauma around the ankle and knee requiring radiographic evaluation of both joints were enrolled in the study. The inclusion criteria included being 20 and 50 years old; having normal axial, sagittal, and coronal lower limb alignment; lacking previous lower limb injury (such as fractures of the tibia or fibula), ankle or knee sprain; not having previous lower limb surgery, metabolic or congenital bone diseases, or malignancy. In all cases, a standard Anteroposterior (AP) radiograph of the knee was taken, and then, without changing the limb position or image setting, an AP radiograph of the ankle was obtained. The overlap between the distal tibia and fibula was measured in the PACS program environment. Results: Fifty cases were included in this study. The Mean±SD ages of males and females were 29.08±2.49 years and 31.46±2.04 years, respectively. The range of distal tibia-fibula overlap one centimeter above the tibiotalar joint line was 7.81 to 9.09 mm (confidence interval of 95%), and its percentage to the fibula shaft width at the same level was 49.43% to 54.35%. Conclusion: According to the results, distal tibia-fibula overlap when the knee is in the true AP position, regardless of the side and gender, is 7.81 to 9.09 mm or 49.43% to 54.35%.

Varus inclination of the tibia is related to patellofemoral osteoarthritis in Japanese female patients with moderate knee osteoarthritis.

The aim of this study was to investigate whether the tibial tuberosity-trochlear groove (TT-TG) distance and lateral patellar tilt, which induce patellofemoral osteoarthritis (OA), are related to the coronal deformity of the lower limb in varus knee OA. It was hypothesized that varus inclination of the tibia was negatively correlated with the TT-TG distance and lateral patellar tilt in Japanese female patients with moderate knee OA. A total of 104 female patients (139 knees) scheduled to undergo knee osteotomy for varus knee OA were enrolled. The coronal lower limb alignment was measured on anteroposterior whole-leg radiographs. The TT-TG distance, patellar tilt angle, and the patellofemoral joint space were measured both medially and laterally on computed tomography images. The correlations between coronal lower limb alignment and the TT-TG distance or patellar tilt angle, and the correlations between the TT-TG distance or patellar tilt angle and patellofemoral joint space were evaluated. The medial proximal tibial angle was negatively correlated with the TT-TG distance (r = - 0.383, P < 0.01) and patellar tilt angle (r = - 0.34, P < 0.01). Lateral patellofemoral joint space was negatively correlated with the TT-TG distance (r = - 0.256, P = 0.002) and patellar tilt angle (r = - 0.205, P = 0.016). Varus inclination of the proximal tibia may induce lateralization of the tibial tuberosity and lateral patellar tilt. The tibial tuberosity lateralization and lateral patellar tilt may induce lateral patellofemoral OA in patients with varus knee OA. III.

What sports medicine practitioners should know about imaging for femoro-patellar pathologies

Clinical imaging in patellofemoral disorders is fundamental for the understanding of the pathology, and to find the adequate treatment option. Anatomical risk factors such as trochlear dysplasia, patella alta, lateralized tibiale tubercle (measured by the tibiale tubercle trochlear groove distance), torsional or coronal lower limb alignment that are the origine of patellar maltracking or even patellar dislocation, can be assessed with high reliability on conventional radiographs combined with MR imaging. The conservative and surgical treatment will highly rely on these findings. The importance of clinical imaging in unspecific anterior knee pain is less clear. It is mostly performed to exclude structural injuries, however is rarely reliable to diagnose the painful structure. Critical appraisal of morphological risk factors is necessary especially in the treatment of anterior knee pain, since fortuitous pathological findings are frequent.

What sports medicine practitioners should know about imaging for femoro-patellar pathologies

Clinical imaging in patellofemoral disorders is fundamental for the understanding of the pathology, and to find the adequate treatment option. Anatomical risk factors such as trochlear dysplasia, patella alta, lateralized tibiale tubercle (measured by the tibiale tubercle trochlear groove distance), torsional or coronal lower limb alignment that are the origine of patellar maltracking or even patellar dislocation, can be assessed with high reliability on conventional radiographs combined with MR imaging. The conservative and surgical treatment will highly rely on these findings. The importance of clinical imaging in unspecific anterior knee pain is less clear. It is mostly performed to exclude structural injuries, however is rarely reliable to diagnose the painful structure. Critical appraisal of morphological risk factors is necessary especially in the treatment of anterior knee pain, since fortuitous pathological findings are frequent.

Impact of Coronal Alignment in Total Knee Arthroplasty and Functional Outcome

Total Knee Arthroplasty (TKA) is a procedure to replace the diseased or damaged knee joint with artificial prosthesis for the relief of disabling pain and restoring the function of knee. Total Knee Arthroplasty (TKA) is one of the most common and successful procedures in modern orthopedics and is spreading through the world. Many surgeons are developing their skill but it needs experience and patience for successful outcomes. There are different factors which affect the outcome after total knee arthroplasty, among them; the coronal alignment of lower limb plays a major role. Many studies have supported that neutral mechanical alignment after total knee arthroplasty leads to better function. The aim of this review is to evaluate clinical outcome with reference to the coronal alignment of the limb and safety based on Western Ontario and McMaster Universities (WOMAC), Knee Society Score (KSS) score.

Coronal lower limb alignment in normal knees—A radiographic analysis of 797 normal knee subjects

BackgroundThis study aimed to resolve uncertainty regarding sex differences in alignment changes with age. MethodsWe measured various parameters of weight-bearing long leg radiographs of 797 legs without osteoarthritic changes, which were classified according to sex and age (young [15–39years], middle-aged [40–54years], aged [55–69years], and elderly [≥70years]), and performed morphological analysis of the lower extremities. The mean measurements in each group were calculated and compared among the groups. ResultsIn the young and middle-aged populations, the femorotibial angle was significantly more varus in male than in female participants (p<0.001). In addition, medial femoral bowing was seen both in male and female participants, but it was more significant in male participants (p<0.005). This was due to greater femoral condylar orientation (p<0.01) and tibial plateau inclination (p<0.01) in male participants compared to female participants with nearly identical joint space narrowing. In aged and elderly populations, on the contrary, lateral femoral bowing was seen in both male and female participants, and there were no differences in any measured values, including the femorotibial angle, between male and female participants. ConclusionsIn relatively young Japanese individuals, male participants' femorotibial angles were more varus and had more medial femoral bowing than female participants, while there was no difference in any measured values between male and female participants in older adults by a radiographic analysis on the alignment of the lower extremities.Level of evidence: Level 2.