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The tibial lateral axis is a novel extraarticular landmark for detection of the tibial anteroposterior axis

Surgical and Radiologic Anatomy volume 42, pages 1195–1202 (2020)Cite this article

Abstract

Purpose

Although the tibial rotation axis is significant in knee arthroplasty, no reliable extraarticular landmark has been proposed. We hypothesized that the tibial lateral axis (TLA), a tangential line of the lateral tibial surface, is perpendicular to the surgical epicondylar axis (SEA) and compared it to other existing landmarks by 3D-CT.

Methods

Fifty legs in 25 consecutive patients were studied. Using their preoperative CT, the TLAs were identified on slices at 10–50% of the total length of the tibia and the measured differences of angles against the line perpendicular to the SEA (the tibial AP axis) were calculated. The differences between the SEA and the femoral and tibial posterior condylar axis, Akagi’s line and the line between the medial intercondylar spine and the medial border of the patellar tendon (sAP line)(intraarticular), the ankle axis, and the transmalleolar axis (extraarticular) were also calculated and compared.

Results

The mean values of TLA at 10%, 20%, 30% were virtually parallel to the SEA (0.97° ± 4.84°, 0.02° ± 4.61°, 1.10° ± 4.97°, respectively). They were equivalent to existing intraarticular landmarks and superior to existing extraarticular landmarks, and these levels corresponded to the tip to the lower end of the tibial tubercle (at 10.8% and 17.0% of total tibial length).

Conclusion

The proximal TLAs can be an extraarticular bony landmark that indicates the line perpendicular to the SEA. A prospective study is needed to prove the validity and accuracy of the axes clinically.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Affiliations

  1. Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan

    Takafumi Hiranaka, Toshikazu Tanaka, Takaaki Fujishiro, Kensuke Anjiki, Naosuke Nagata, Daiya Kitazawa, Ken Kotoura & Koji Okamoto

Authors
  1. Takafumi Hiranaka
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  2. Toshikazu Tanaka
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  3. Takaaki Fujishiro
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  4. Kensuke Anjiki
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  5. Naosuke Nagata
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  6. Daiya Kitazawa
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  7. Ken Kotoura
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  8. Koji Okamoto
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Contributions

TH: protocol and project development, data collection or management, data analysis and manuscript writing and editing. TT, TF, KA, NN, DK, KK, KO: manuscript editing.

Corresponding author

Correspondence to Takafumi Hiranaka.

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The authors declare no conflicts of interest in relation to this study.

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This study was approved by Institutional Review Board in Takatsuki General Hospital.

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Written informed consent was obtained in every patient.

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Hiranaka, T., Tanaka, T., Fujishiro, T. et al. The tibial lateral axis is a novel extraarticular landmark for detection of the tibial anteroposterior axis . Surg Radiol Anat 42, 1195–1202 (2020). https://doi.org/10.1007/s00276-020-02513-8

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  • DOI: https://doi.org/10.1007/s00276-020-02513-8

Keywords

  • Knee arthroplasty
  • Bony Landmark
  • Anteroposterior axis
  • Anatomy