Purpose: The restoration of the normal joint line (JL) is important both in primary and revision total knee arthroplasty (TKA). However, the assessment of the femoro-tibial JL is still controversial. A strong correlation between femoral width (FW) and distance from adductor tubercle (AT) to JL was found on radiographs, with a ratio of 0.54. The hypothesis was that this ratio was applicable also in the surgical theatre by using measurements obtained intra-operatively with a caliper.Methods: Femoral width, AT to JL distance and the RATIO between AT to JL distance and FW of 40 patients who underwent TKA were measured on radiograph and intra-operatively. Bland–Altman agreement tests with repeated measurements and linear regression analysis were used. The ratio was used to estimate the distance between JL and AT.Results: The AT to JL distance/FW ratio calculated with linear regression resulted 0.54 for radiographic measurements and 0.53 for intra-operative measurements. There was no difference (0.009 ± 0.03) between the calculated ratios on radiographic and intra-operative measurements, and the correlation between intra-operative and radiographic measurements was 0.5 (p = 0.0016).Conclusions: This study shows that the validity of the radiographic method which uses an AT to JL distance/FW ratio to determine the level of the JL is confirmed also when using intra-operatively acquired measurements. Thus, this ratio represents a reliable tool to determine the JL level even in challenging prosthetic revision cases when the anatomical JL is missing.Level of evidence: Case series, Level IV.
The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre / F. Iacono;G. F. Raspugli;D. Bruni;G. Filardo;S. Zaffagnini;W. F. Luetzow;M. L. Presti;I. Akkawi;G. M. Marcheggiani;M. Marcacci. - In: KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY. - ISSN 0942-2056. - STAMPA. - 22:12(2014), pp. 3034-3038. [10.1007/s00167-013-2809-0]
The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre.
G. F. Raspugli;FILARDO, GIUSEPPE;ZAFFAGNINI, STEFANO;MARCACCI, MAURILIO;Iacono, F.;Bruni, D.;Lo Presti, M.;Akkawi, I.;Muccioli, G. M. Marcheggiani
2014
Abstract
Purpose: The restoration of the normal joint line (JL) is important both in primary and revision total knee arthroplasty (TKA). However, the assessment of the femoro-tibial JL is still controversial. A strong correlation between femoral width (FW) and distance from adductor tubercle (AT) to JL was found on radiographs, with a ratio of 0.54. The hypothesis was that this ratio was applicable also in the surgical theatre by using measurements obtained intra-operatively with a caliper.Methods: Femoral width, AT to JL distance and the RATIO between AT to JL distance and FW of 40 patients who underwent TKA were measured on radiograph and intra-operatively. Bland–Altman agreement tests with repeated measurements and linear regression analysis were used. The ratio was used to estimate the distance between JL and AT.Results: The AT to JL distance/FW ratio calculated with linear regression resulted 0.54 for radiographic measurements and 0.53 for intra-operative measurements. There was no difference (0.009 ± 0.03) between the calculated ratios on radiographic and intra-operative measurements, and the correlation between intra-operative and radiographic measurements was 0.5 (p = 0.0016).Conclusions: This study shows that the validity of the radiographic method which uses an AT to JL distance/FW ratio to determine the level of the JL is confirmed also when using intra-operatively acquired measurements. Thus, this ratio represents a reliable tool to determine the JL level even in challenging prosthetic revision cases when the anatomical JL is missing.Level of evidence: Case series, Level IV.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.