Lateral Tibial Spine Research Articles

Decreased sagittal slope of the medial tibial spine and deep concavity of the lateral tibial spine are risk factors for noncontact anterior cruciate ligament injury.

This study aimed to assess the relationship between the geometric features of tibial eminence and susceptibility to noncontact anterior cruciate ligament (ACL) injuries. Patients with unilateral noncontact knee injuries between 2015 and 2021 were consecutively enroled in this study. Based on knee magnetic resonance imaging (MRI) and arthroscopic visualisation, patients were categorised into the case group (ACL rupture) and control group (ACL intact). Using MRI, the geometric features of tibial eminence were characterised by measuring the sagittal slopes, depth of concavityand coronal slopes of the inclined surfaces of the tibial spines. Univariate and multivariate logistic regressions were conducted to explore independent associations between quantified geometric indices of tibial eminence and the risk of noncontact ACL injuries. This study included 187 cases and 199 controls. A decreased sagittal slope of the medial tibial spine (MTSSS) (combined group: odds ratio [OR]: 0.87 [0.82, 0.92], p < 0.001; females: OR: 0.88 [0.80, 0.98], p = 0.020; males: OR: 0.87 [0.81, 0.93], p < 0.001) and an increased depth of concavity in the lateral tibial spine (LTSD)(combined group: OR: 1.51 [1.24, 1.85], p < 0.001; females: OR: 1.65 [1.12, 2.43], p = 0.012; males: OR: 1.44 [1.11, 1.89], p = 0.007) were independent risk factors for noncontact ACL injuries. Moreover, a steeper coronal slope of the inclined surface of the medial tibial spine was a significant predictor of noncontact ACL injuries for males (MTSCS: OR: 1.04 [1.01, 1.08], p = 0.015) but not for females. Geometric features of tibial eminence, particularly a decreased MTSSS and an increased LTSD, were identified as independent risk factors for noncontact ACL injuries. These findings will help clinicians identify individuals at high risk of ACL injury and facilitate the development of targeted prevention strategies. Level III.

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Background: Several techniques have been used by surgeons for anatomic tibial tunnel placement in anterior cruciate ligament (ACL) reconstruction, including the ACL stump positioning (ASP) technique and the tibial spine positioning (TSP) technique. Purpose/Hypothesis: The purpose of this study was to evaluate whether bony landmarks (medial and lateral tibial spine [MLTS]) can be a reliable reference for improving the accuracy of tibial tunnel placement in anatomic single-bundle ACL reconstruction compared with the ACL stump. It was hypothesized that the MLTS would not be a reliable bony landmark for tibial tunnel placement. Study Design: Cohort study; Level of evidence, 3. Methods: The 3-dimensional computed tomography images of 111 patients who underwent ACL reconstruction between 2020 and 2021 were included in this study. For tibial tunnel placement, the ASP technique was used in 49 patients, and the TSP technique was used in 62 patients. The 3-dimensional computed tomography images were reconstructed to enable measurements of the locations of the MLTS and tunnel center based on a grid method. Statistical analysis was conducted to compare the MLTS location and tibial tunnel position as well as the accuracy (mean distance of each actual location from the anatomic center) and precision (standard deviation of the accuracy, indicating the reproducibility of the tunnel position) of the tunnel position between the ASP and TSP groups. Results: Significant differences were observed between the ASP and TSP groups in terms of the tibial tunnel position on the mediolateral axis (46.7% ± 2.0% vs 45.9% ± 2.2%, respectively; P = .034), while no significant differences were found in terms of the accuracy (4.1% vs 4.6%, respectively; P = .259) or precision (2.1% vs 2.1%, respectively; P = .259) of tibial tunnel positioning between the 2 groups. Conclusion: In anatomic single-bundle ACL reconstruction, the use of the MLTS for tibial tunnel placement achieved comparable accuracy and precision compared with the use of ACL remnants, supporting its role as a reliable bony landmark in tibial tunnel positioning.

Anatomical Study of the Lateral Tibial Spine as a Landmark for Weight Bearing Line Assessment during High Tibial Osteotomy.

Background: Accurate pre-operative planning is essential for successful high tibial osteotomy (HTO). The lateral tibial spine is a commonly used anatomical landmark for weight-bearing line assessment. However, studies on the mediolateral (M-L) position of the lateral tibial spine on the tibial plateau and its variability are limited. Purpose: This study aimed to (1) analyze the M-L position of the lateral tibial spine on the tibial plateau and its variability, (2) investigate radiologic parameters that affect the position of the lateral tibial spine, and (3) determine whether the lateral tibial spine can be a useful anatomical landmark for weight-bearing line assessment during HTO. Materials and Methods: Radiological evaluation was performed on 200 participants (64% female, mean age 42.3 ± 13.2 years) who had standing anterior-posterior plain knee radiographs with a patellar facing forward orientation. The distances from the medial border of the tibial plateau to the lateral spine peak (dLSP) and lateral spine inflection point (dLSI) were measured using a picture archiving and communication system. The medial-lateral inter-spine distance (dISP) was also measured. All parameters were presented as percentages of the entire tibial plateau width. The relationships between the parameters were also investigated. Results: The mean value of dLSP was 56.9 ± 2.5 (52.4-64.5)%, which was 5% lower than the Fujisawa point (62%). The mean value of dLSI was 67.9 ± 2.2 (63.4-75.8)%, which was approximately 5% higher than the Fujisawa point. The values of the dLSP and dLSI were variable among patients, and the upper and lower 10% groups showed significantly higher and lower dLSP and dLSI, respectively, than the middle 10% group. The mean value of dISP was 16.5 ± 2.4%, and it was positively correlated with dLSP and dLSI. Conclusions: On average, the dLSP and dLSI were located -5% and +5% laterally from the conventional Fujisawa point, and they may be useful landmarks for correction amount adjustment during HTO. However, it should be noted that correction based on the lateral tibial spine can be affected by anatomical variations, especially in patients with small or large inter-spine distances.

The position of the lateral tibial spine and the implications for high tibial osteotomy planning

The lateral tibial spine (LTS) is frequently proposed as a correction target in high tibial osteotomy (HTO), although little is known about its exact radiographic position. This study primarily aims to define the position and variance of the LTS. Secondly, this study wants to investigate the relevance of the LTS position on the mechanical tibiofemoral angle (mTFA°) while planning and postoperatively landing the weight-bearing line (WBL) on this landmark. The LTS position was studied on preoperative full-leg standing radiographs (FLSR) and computed tomography (CT) scans in 70 cases. 3D models of the tibia were created in Mimics 23.0 and measurements were conducted in 3-matic 15.0 (Materialise, Leuven®). Next, 100 HTO cases were retrospectively planned with the WBL through the LTS according to Dugdale’s method on FLSR. Finally, 55 postoperative FLSR which had the WBL on the LTS (±2%) were assessed for mTFA° outcome. Statistics were conducted in GraphPad 8.0. The LTS was located at 58.3%±1.9 [55-63%] in 2D and 57.3%±2.2 [53-63%] in 3D showing a high correlation (r=0.77 [0.65 to 0.85]). The planned mTFA on the LTS was 181.8°±0.3 (181.3°-182.5°). On postoperative FLSR, the mTFA was 182.2°±0.6 (180.9°-183.1°). The lateral tibial spine is located at 57-58% on the tibial plateau with a 10% maximal variation range. Good agreement was found between 2D and 3D imaging modalities while evaluating its position in the coronal plane. When aiming the WBL through the LTS during valgus-producing HTO, a consistent realignment of 181-183° mTFA can be expected when performing accurate surgery.

Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study

PurposeContemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short-term clinical outcomes when using 3D planning and a patient-specific instrumentation (PSI) kit to prepare customized bone allografts.MethodsThirty subjects (age 48y ± 13) were included in a double-center prospective case series. A low-dose CT-scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ-5D and anchor questions. A linear-mixed model approach was implemented for data analysis.ResultsPreoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001).ConclusionThe study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.

Risk Factors of Loss of Knee Range of Motion after Primary Anterior Cruciate Ligament Reconstruction following Preoperative Recovery of Knee Range of Motion.

The loss of knee range of motion (ROM) is not an uncommon complication after anterior cruciate ligament reconstruction (ACLR). However, the risk factors of loss of knee ROM remain debatable. The purpose of this study was to evaluate the incidence and risk factors of loss of knee ROM at 12 months after primary ACLR performed after regaining full knee ROM preoperatively. Consecutive patients who underwent primary ACLR after regaining full ROM between January 2014 and January 2020 were retrospectively reviewed. Patients who received a surgical arthrolysis within 12 months after ACLR or those who had a loss of knee ROM at 12 months postoperatively were defined as the loss of ROM group. Possible risk factors of loss of knee ROM, including patient demographic, preoperative, surgical, and postoperative factors, were assessed. The notch wide index and radiographic parameters of the tibial spines; medial tibial spine height/tibial length (TL), lateral tibial spine height (LTSH)/TL, and tibial spine width (TSW)/TL, were also assessed. A total of 141 patients (141 knees) were included (mean age, 25.8 ± 11.4 years; male/female, 56/85). Of the 141 patients, three received surgical arthrolysis within 12 months, and 23 had a loss of knee ROM at 12 months after ACLR. On comparing patients with and without loss of knee ROM, significant differences were found in the age (p = 0.04), LTSH/TL (p = 0.02), and TSW/TL (p = 0.02). A multivariate regression analysis showed that the age (odds ratio [OR]; 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.02), LTSH/TL (OR: 1.44, 95% CI: 1.01-2.1, p = 0.04), and TSW/TL (OR: 0.79, 95% CI: 0.65-0.97, p = 0.02) were identified as significant independent risk predictors of loss of knee ROM. This study showed that the incidence of loss of knee ROM at 12 months after primary ACLR was 18.4% (26/141). An older age, a higher LTSH/TL, and a smaller TSW/TL may be associated with loss of knee ROM at 12 months after ACLR.

Evaluation of tibial eminence morphology using magnetic resonance imaging (MRI) in juvenile patients with complete discoid lateral meniscus

BackgroundMany studies have shown that hypoplasia of knee bone morphology is related to the morphological features of the discoid lateral meniscus (DLM). However, few studies have focused on hypoplasia of tibial eminence morphology in juvenile patients with complete DLM. The purpose of this study was to determine the relationship between tibial eminence morphology characteristics and complete DLM in juvenile patients.MethodsThe DLM group comprised 34 juvenile patients with complete DLM, and the control group comprised 34 juvenile individuals, each with a normal lateral meniscus based on magnetic resonance imaging (MRI) findings. All parameters, including tibial width (TW), tibial eminence width (TEW), the height of the lateral tibial spine (HLTS), the height of the medial tibial spine (HMTS), lateral slope angle of the lateral tibial eminence (LSALTE), lateral slope angle of the medial tibial eminence (LSAMTE), tibial eminence width ratio (TEWR), height of the lateral tibial spine ratio (HLTSR), and the height of the medial tibial spine ratio (HMTSR), were recorded using coronal MR images. Statistical analyses were used to determine the differences between the two groups and whether differences were significant.ResultsThe TEW and TEWR were significantly greater (P < 0.05), and LSALTE and LSAMTE were significantly smaller (P < 0.05) in patients in the DLM group than in participants in the control group. Receiver operating characteristic (ROC) analysis revealed that a larger TEW, above 13.4 mm, was associated with complete DLM, with a sensitivity of 77.0% and specificity of 88.2%, and a larger TEWR, above 19.7%, was associated with complete DLM, with a sensitivity of 76.5% and specificity of 91.2%.ConclusionsMR imaging can be used to diagnose tibial eminence hypoplasia in juvenile patients with complete DLM. Additionally, TEW and TEWR could help clinicians screen for complete DLM in juvenile patients.

Tibial Spine Height Measured by Radiograph Is a Risk Factor for Non-Contact Anterior Cruciate Ligament Injury in Males: A Retrospective Case-Control Study

Various anatomic abnormalities are implicated in non-contact anterior cruciate ligament (ACL) injury, but researchers rarely deal with the relation between tibial spine height and ACL injury. We conducted a retrospective case-control study to include 96 patients with and without non-contact ACL injuries. Tibial plateau width (TPW), medial and lateral tibial spine height (MTSH and LTSH), and tibial spine width (TSW) were measured by radiographs. The parameters were compared among subgroups. Binary regression mode, receiver operating characteristic curves, and the area under the curve (AUC) were used to evaluate the specific correlation of the parameters with ACL injury. As a result, we found that the ratio of LTSH/TPW was larger in ACL-injured patients than in ACL-intact controls (p = 0.015). In the study group, LTSH/TPW (p = 0.007) and MTSH/TPW (p = 0.002) were larger in males than in females. The ratio of LTSH/TPW had an AUC of 0.60 and a significant OR of 1.3 for ACL injury in males, but not in females. In conclusion, LTSH was larger in patients with ACL injury and is a risk factor for ACL injury in males. The impact of increased LTSH on the impingement between the grafts and lateral tibial spine during ACL reconstruction warrants further investigation.

Hemi-high tibial osteotomy: technical note and case report

High tibial osteotomy (HTO) is a widely performed procedure, with several surgical techniques described to treat varus mal-alignment and medial compartment arthrosis of the knee. In our case report, we present a new surgical technique for performing a medial open wedge HTO in a young patient with proximal varus deformity of the right knee to avoid the clinical complications of HTO. A longitudinal medial incision was made medially over the proximal tibia, the medial collateral ligament (MCL) split, and an osteotomy was made from the medial cortex exiting into the “lateral tibial spine”. The osteotomy was then opened. A wedge measured 12.5 mm, and a bone graft harvested from the right iliac crest was used to fill the defect, followed by a Puddu plate placement. We had planned to have the osteotomy exit in the centre of the knee. Two years postoperatively, complete osteotomy healing and full range of right knee movement with no pain were observed. Radiographs confirmed deformity correction. Many surgical techniques have been described for HTO, including closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy. We believe that in this technique, the risk of nonunion is less, the construct is more stable, and the patient will have a faster rehabilitation program with early weight-bearing. Hemi-HTO is a new surgical technique that can be used to treat proximal varus deformity of the knee, especially if the lateral tibial plateau appears radiologically normal.

Trans patellar tendon sagittal tibial cut for lateral unicompartmental knee arthroplasty-location of the split- CT simulation study

BackgroundIn lateral unicompartmental knee arthroplasty (UKA), a sagittal cut is often performed through the patellar tendon (PT). Although the approach is likely widely used, it has not been described in detail, especially regarding the site of the split. This study aimed to clarify where the split should be made. MethodsThis single-center retrospective cohort study included 49 consecutive patients and 51 knees with lateral osteoarthritis. Using preoperative computed tomography, we measured the distance from the medial edge of the PT to the intersection of the PT and the sagittal cutting line, defined as a line parallel to the Akagi's line and passing the tip of the lateral tibial spine. ResultsThe sagittal cut line passed a mean of 45 ± 11% of the patellar tendon width from the PT medial edge. ConclusionsThe tendon split should be made just medial to the center of the PT because it is where the sagittal cut line for lateral UKA passes.

Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus

Background:Debate persists regarding which radiographic measurements are important when investigating a possible discoid lateral meniscus and the utility of x-rays in the diagnostic workup.Hypothesis/Purpose:The purpose of this study was to identify differences in various measurements between healthy knees and those with a discoid meniscus while controlling for other patient characteristics.Methods:Radiographs of patients with a confirmed discoid lateral meniscus were matched by age and sex to those with a healthy knee (verified by magnetic resonance imaging). The following parameters were associated with discoid meniscus in previous studies and were measured on x-ray for each subject: lateral joint space height (both in the central and medial portion of the compartment; LJSH-C and LJSH-M, respectively), medial joint space height, fibular head height (FHH), lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Ratios were calculated between LJSH-C/M and medial joint space height. Univariate analysis was followed by multivariate regression to adjust for confounders.Results:The study included 57 patients with a discoid meniscus and 55 controls with a mean age of 11.0±3.5 years (50% female). The median LJSH-C for subjects with a discoid meniscus was 7.3 mm [interquartile range (IQR) 2.1] compared to 5.8 mm (IQR 2.2) in normal knees (p<0.001). A similar difference was found for LJSH-M [6.9 mm (IQR 2.9) vs. 5.4 mm (IQR 2.4), p=0.002]. Mean FHH was lower for discoid menisci than controls (12.5±4.0 mm vs. 14.9±5.9 mm, p=0.01). No other radiographic measurements were significantly different between cases and controls. When adjusting for covariates in regression analysis, the presence of a discoid meniscus was predictive of a higher LJSH-C and LJSH-M and lower FHH. Of note, age and sex were also significantly predictive in these models. Patients with a discoid meniscus had 3.5 times higher odds of LJSH-C ≥7 mm [95% confidence interval (CI) 1.5-8.3, p=0.005), 3.3 times higher odds of LJSH-M ≥6 mm (95% CI 1.4-7.9, p=0.006), and 3.1 times higher odds of FHH <16 mm (95% CI 1.2-7.8, p=0.02).Conclusion:After controlling for other factors, LJSH-C, LJSCH-M, and FHH on plain radiographs were associated with a discoid lateral meniscus. However, many previously reported measurements were not predictive. While these parameters may aid diagnostic decision making when there is suspicion for a discoid meniscus, age and sex must also be considered. Advanced imaging may be required to confirm the diagnosis.

Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures.

To determine the effect of native tibia valga on intramedullary nail (IMN) fixation of tibial shaft fractures. Retrospective comparative cohort analysis of 110 consecutive patients with tibial shaft fractures undergoing IMN fixation at an urban level one trauma centrewas performed. Medical records and radiographs were reviewed for demographics, tibia centre of rotation of angulation (CORA), nail starting point, incidence of varus malreduction, and nail/canal proportional fit. Tibia valga (CORA of ≥ 3 degrees) was present in 37 (33.6%) patients. The anatomic nail starting point distance (in relation to the lateral tibial spine) was significantly greater in the tibia valga group (12.0mm vs. 5.0mm, mean difference: 7.1mm, 95% CI: 5.8 to 8.3mm, p < 0.0001). Varus malreduction was more common in the tibia valga group (10.8% vs. 1.4%, proportional difference: 9.4%, 95% CI: - 1.0 to 21.3%, p = 0.04). Varus malreduction in the tibia valga group was associated with a decreased nail width/inner canal width proportion on multivariate analysis (OR = 0.683, 95% CI: 0.468 to 0.995, p = 0.0004). Native tibia valga is common, and the use of a standard coronal IMN starting point with poor nail fit can lead to iatrogenic varus malreduction. In patients with tibia valga, maximizing nail fit or utilization of a medial starting point should be considered.

Is the lateral tibial spine a reliable landmark for planning tibial or femoral valgus osteotomies?

IntroductionA valgus osteotomy around the knee is a conservative procedure performed to unload the medial tibiofemoral compartment. However, the optimal postoperative alignment target remains controversial. Many studies have applied a “Fujisawa point” at 62.5%. The results of recent studies suggest decreasing the range of the mechanical axis target correction to 50–55%. The primary purpose of this study was to define the mean position of the lateral tibial spine in healthy patients from a reproducible 3-dimensional (3D) analysis. The study hypothesis was that the apex of the lateral tibial spine was a reliable and reproducible landmark for planning valgus osteotomies and preventing overcorrections. Materials and methodsThe study included 1140 patients: 560 women and 580 men, with a mean age of 61.7±16.5 years (18–98) and a mean body mass index (BMI) of 24.9±4.9kg/m2 (13.3–54.6). This analysis was done with the Stryker Orthopaedics Modeling and Analytics (SOMA) system which uses a database of computed tomography (CT) scans and 3D bone models. A statistical assessment was performed to determine the mean position of the lateral tibial spine. These measurements were then compared according to ethnicity, sex, age, BMI, knee side (right and left) and the overall mechanical axis of the leg. ResultsThe mean tibial plateau width was 72.9±5.7mm (59.1–91.1). The mean position of the lateral tibial spine was 53.6±1.1% (48.9–57.2). The mean position of the medial tibial spine was 48.4±2.5% (43.6–56.1) while the center of the tibial spines was 51.0±1.5% (46.4–56.1). Africans had a significantly more lateral mean tibial spine position than Asians (54.7% vs. 53.3%, p=0.001), Caucasians (54.7% vs. 53.7%, p=0.002) and Middle Easterners (54.7% vs. 53.6%, p=0.034). ConclusionThe lateral tibial spine is a simple and reproducible bony landmark. This landmark can be used when planning valgus osteotomies aiming for a “Fujisawa point” at 54%. Level of evidenceIV.

Focal dome condylar osteotomy: Early results of alignment of a combined intra- and extra-articular high tibial osteotomy

Background and Aims: Extra-articular high tibial osteotomies reliably treat varus deformities seen in medial compartment osteoarthritis of knee (MCOA). Recently, attention has turned to the detection and treatment of intra-articular knee deformity to treat MCOA. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy (IAO) that corrects the varus by elevating the medial tibial condyle and is fixed with a plate. TCVO improves joint line convergence angle (JLCA), spine edge angle (SEA), and spine vertical distance (SVD), which measure intra-articular deformity. It may undercorrect the mechanical axis to <50%. Focal dome condylar osteotomy (FDCO) is recently described and claims to correct both the intra- and extra-articular deformities in MCOA. We aimed to study the immediate results of FDCO and compare its efficacy with TCVO. Patients and Methods: We performed ten FDCO procedures on ten patients over the last year. The mean age was 57 years. We compared the results with a similar retrospective cohort of ten TCVO patients. Results: The mean preoperative (bo) mechanical axis deviation (MAD) in FDCO was −13.8% and improved to 51.6%. TCVO group had a similar mean postoperative (po) MAD of 43.5% (P = 0.38). Although 6 of 10 FDCOs had MAD >50%, only two of TCVOs crossed the midline. The mean bo medial proximal tibial angle in FDCO was 85.9° and improved significantly po to 93°. Hip knee ankle angle, ankle joint line orientation, and knee joint line orientation improved significantly as did JLCA, SEA, and SVD. Condylar plateau angle did not change. Conclusion: FDCO is an IAO with a vertical limb that passes through the lateral tibial spine and a medial curved limb. This single osteotomy can correct the intra-articular and extra-articular varus deformity. Although there was no significant difference in the correction of intra- and extra-articular deformity parameters between FDCO and TCVO, we feel that it was part of our learning curve. FDCO has the potential for better correction of the mechanical axis along with intra-articular deformities.

Possible role of MRI-detected osteophytes as a predictive biomarker for development of osteoarthritis of the knee: A study using data from the Osteoarthritis Initiative

ObjectiveTo elucidate the possible role of MRI-detected osteophytes as a predictive imaging biomarker for knee osteoarthritis (KOA). DesignSubjects (n ​= ​303) were selected according to the following inclusion criteria from the Osteoarthritis Initiative (OAI) data set: (1) ​< ​55 years old; (2) Western Ontario and McMaster Universities Arthritis Index pain score of 0; (3) Kellgren-Lawrence (KL) system grade 0 or 1; and (4) Complete MRI data set of the right knee. A pre-OA group (POA) consisted of subjects who developed KL grade 2 or more within 96 months, and a non-OA group (NOA) that remained KL 0 or 1 during that period. Baseline MRIs were assessed for osteophyte formation. Twenty-five locations were examined according to the MOAKS osteophyte score. Osteophytes at each location were assessed in terms of their predictive value for OA development. ResultsThirty-two subjects were POA and 271 were NOA. Age, BMI, and sex did not differ between the two groups. In the POA group, the number of subjects with osteophytes tended to be higher at all 25 sites. Forward stepwise regression analysis revealed five locations - medial patella, lateral intra-condylar notch of the femur, lateral femoral condyle, tibial spine, and lateral posterior condyle - were important for the prediction of KOA development. Having more than two osteophytes at these five locations predicted KOA development with a sensitivity of 0.75 and specificity of 0.79. ConclusionsMRI-detected osteophytes could serve as a predictive biomarker of KOA development within 96 months after detection.

Evaluation of anatomical axis-joint center distance and anatomical axis-joint center ratio in distal femur and proximal tibia in coronal plane of Indian population

BackgroundRadiographic evaluation of the anatomical geometry of the bone is important for executing reconstructive surgeries like deformity correction, limb lengthening and joint replacements. Various studies have been done in the past to define the anatomic placement of implant inside the bone. The aim of this study is to evaluate the distance between the anatomical axis and joint center of the distal femur (aJCD-f) and proximal tibia (aJCD-t) along with the ratio of anatomical axis-joint center distance of distal femur (aJCR-f) and proximal tibia (aJCR-t) of the skeletally mature individual of Indian population along with its application in day to day practice. MethodsData is procured from the standard radiographs of the knee on large films. The anatomical axis is drawn on both sides of tibia and femur in a standard fashion. These lines intersect the horizontal drawn line at the intercondylar notch of femur and joint orientation line of the tibia. The aJCD-f, aJCD-t, aJCR-f, aJCR-t are then measured. Also the center of the inter-spinous distance of the tibia is measured from the anatomical axis (aSCD-t). ResultsA total of 182 x-rays of skeletally mature individual were included with mean age of 46.35 ± 13.93 years. Of them 81 were males and 101 were females. There were 89 x-ray of left side and 93 x-ray of right side. The mean width of the femur at the intercondylar notch is found to be 76.78 mm (±7.40). The mean aJCD-f is found to be 3.87 mm (±2.44), aJCR-f to be 0.50 (±0.06). The mean width of the tibia is found to be 76.80 mm (±6.48). The aJCD-t is found to be 2.20 mm (±1.41), aJCR-t to be 0.50 (±0.03). The aSCD-t at the level of tibial spine is found to be −0.23 mm (±2.84). There was significant difference in the width of the femoral condyle of males 82.13 mm (±0.65) and females 72.48 mm (±0.55). Males showed mean aJCD-f of 3.59 mm (±2.42) and females showed 4.10 mm (±2.46). The aJCR-f is found to be significantly different between males 0.49 (±0.05) and females 0.51 (±0.07). There is significant difference between the width of the proximal tibia between males 80.83 mm (±0.68) and females 73.56 mm (±0.46). The aJCD-t of males and females is found to be 2.28 mm (±1.25) and 2.16 mm (±1.54) respectively. The aJCR-t is found to be significantly different between males 0.49 (±0.03) and females 0.50 (±0.04). While the mean distance of the anatomical axis from the lateral tibial spine is 0.23 mm lateral to the center of the inter-spinous distance and is found to be same in both males and females −0.23 mm (±2.84). ConclusionThe coronal plane parameter like aJCD, aJCR of femur and tibia and aSCD-t of tibia can be a useful parameter to calculate in the ‘real world’ settings for reconstructive surgeries like deformity correction, nailing through the knee for femur and tibia as well as replacement surgeries around knee.

Automatic Discoid Lateral Meniscus Diagnosis from Radiographs Based on Image Processing Tools and Machine Learning.

The aim of the present study is to build a software implementation of a previous study and to diagnose discoid lateral menisci on knee joint radiograph images. A total of 160 images from normal individuals and patients who were diagnosed with discoid lateral menisci were included. Our software implementation includes two parts: preprocessing and measurement. In the first phase, the whole radiograph image was analyzed to obtain basic information about the patient. Machine learning was used to segment the knee joint from the original radiograph image. Image enhancement and denoising tools were used to strengthen the image and remove noise. In the second phase, edge detection was used to quantify important features in the image. A specific algorithm was designed to build a model of the knee joint and measure the parameters. Of the test images, 99.65% were segmented correctly. Furthermore, 97.5% of the tested images were segmented correctly and their parameters were measured successfully. There was no significant difference between manual and automatic measurements in the discoid (P=0.28) and control groups (P=0.15). The mean and standard deviations of the ratio of lateral joint space distance to the height of the lateral tibial spine were compared with the results of manual measurement. The software performed well on raw radiographs, showing a satisfying success rate and robustness. Thus, it is possible to diagnose discoid lateral menisci on radiographs with the help of radiograph-image-analyzing software (BM3D, etc.) and artificial intelligence-related tools (YOLOv3). The results of this study can help build a joint database that contains data from patients and thus can play a role in the diagnosis of discoid lateral menisci and other knee joint diseases in the future.

The radiographic tibial spine area is correlated with the occurrence of ACL injury.

The purpose of this study was to reveal the possible influence of the tibial spine area on the occurrence of ACL injury. Thirty-nine subjects undergoing anatomical ACL reconstruction (30 female, 9 male: average age 29 ± 15.2) and 37 subjects with intact ACL (21 female, 16 male: average age 29 ± 12.5) were included in this study. In the anterior-posterior (A-P) and lateral knee radiograph, the tibial spine area was measured using a PACS system. In axial knee MRI exhibiting the longest femoral epicondylar length, the intercondylar notch area was measured. Tibial spine area, tibial spine area/body height, and tibial spine area/notch area were compared between the ACL tear and intact groups. The A-P tibial spine area of the ACL tear and intact groups was 178 ± 34 and 220.7 ± 58mm2, respectively. The lateral tibial spine area of the ACL tear and intact groups was 145.7 ± 36.9 and 178.9 ± 41.7mm2, respectively. The tibial spine area was significantly larger in the ACL intact group when compared with the ACL tear group (A-P: p = 0.02, lateral: p = 0.03). This trend was unchanged even when the tibial spine area was normalized by body height (A-P: p = 0.01, lateral: p = 0.02). The tibial spine area/notch area of the ACL tear and intact groups showed no significant difference. The A-P and lateral tibial spine area was significantly smaller in the ACL tear group when compared with the ACL intact group. Although the sample size was limited, a small tibial spine might be a cause of knee instability, which may result in ACL injury. Level III.

Increased Articular Exposure of the Lateral Tibial Plateau with a Midline Lateral Parapatellar Arthrotomy Compared to an Anterolateral Submeniscal Arthrotomy: a Cadaveric Study

To quantitatively compare the articular exposure of the proximal tibia with a lateral parapatellar arthrotomy through a straight midline incision (ML) versus a lateral submeniscal arthrotomy through a curvilinear anterolateral incision (AL). Eight surgical approaches (4 ML and 4 AL) were performed on 4 fresh cadavers. Access to key articular landmarks was assessed, including divisions of the lateral meniscus, lateral tibial spine, and anterior cruciate ligament. The boundary of the exposed articular surface of the tibia was marked, and the proximal tibias were then stripped of soft tissues. A calibrated digital image was taken of each proximal tibia, and exposed articular surface area was calculated with ImageJ software (NIH, Bethesda, MD). Statistical analysis was performed using a two-sample t-test. Average articular surface area exposed was 2.2 times greater through the midline approach compared with the anterolateral approach (11.2 vs 5.1 cm2, p = 0.010). All key anatomic landmarks were directly visualized through the midline approach in each specimen. Complete visualization of the lateral meniscus posterior horn, lateral tibial spine, and anterior cruciate ligament was not accomplished through the anterolateral approach in any specimen. The midline approach provides more extensive articular exposure of the lateral tibial plateau compared with the anterolateral approach. This improved exposure may offer an advantage when treating fractures not amenable to arthroscopic or minimally invasive techniques. It may be of most use when treating fractures with extension into the posteromedial quadrant of the lateral plateau, fractures with extensive comminution of the lateral plateau, or fractures with complex lateral meniscus tears and fractures with tibial spine involvement.

Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction.

The purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Using postoperative 3D-CT, accurate axial views of the tibia plateau were evaluated. By assuming the medial and anterior borders of the tibia plateau as 0% and the lateral and posterior borders as 100%, the location of the medial and lateral tibial spine, and the center of the tibial tunnel were calculated. Statistical analysis was performed to assess the correlation between tibial spine location and tibial tunnel placement. The medial tibial spine was located at 54.7 ± 4.5% from the anterior border and 41.3 ± 3% from the medial border. The lateral tibial spine was located at 58.7 ± 5.1% from the anterior border and 55.3 ± 2.8% from the medial border. The ACL tibial tunnel was located at 34.8 ± 7.7% from the anterior border and 48.2 ± 3.4% from the medial border. Mediolateral tunnel placement was significantly correlated with medial and lateral tibial spine location. However, for anteroposterior tunnel placement, no significant correlation was found. A significant correlation was observed between mediolateral ACL tibial tunnel placement and medial and lateral tibial spine location. For clinical relevance, tibial ACL tunnel placement might be unintentionally influenced by tibial spine location. Confirmation of the ACL footprint is required to create accurate anatomical tunnels during surgery. This is a Level III; case-control study.