Abstract
Purpose
The posterior tibial slope has a huge influence on the kinematics of the knee. In several orthopedic interventions such as high tibial osteotomy and unicondylar or bicondylar knee replacement changing, the tibial slope can result in altered knee mechanics. Therefore, an exact preoperative measurement of the posterior tibial slope is mandatory. Several methods are used on conventional radiographs and CT scans, but until now there is no standard validated method. The aim of this study was to compare several methods and imaging techniques to measure the posterior tibial slope and to establish a standard and reliable measurement method by radiography.
Methods
Fourteen knees (seven cadavers) were scanned by a 64-slice CT, a 3T-MRI, and true lateral radiographs were performed. The anatomical references (TPAA = tibial proximal anatomical axis; ATC = anterior tibial cortex; PTC = posterior tibial cortex) and the new computed reference (MPA = mean of PTA and ATC) were compared by short as well as long radiographs, CT scan and MRI. The influence of a malrotation in radiographs of the knees was also analyzed.
Results
CT scan and MRI are suitable for the measurement of the medial and lateral posterior tibial slopes, the results of the radiographs varied depending on the method used. The new method (MPA) showed the best correlation to the CT scan (r = 0.997), even on short radiographs (10 cm distal the joint line).
Conclusion
The measurement of the posterior tibial slope on a short lateral radiograph using the MPA is a reliable method and should be established as a standard.
Level of evidence
Diagnostic study, Level II.
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References
Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg; 124:575–584
Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183
Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:193–196
Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A (1996) Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 82:195–200
Chiu KY, Zhang SD, Zhang GH (2000) Posterior slope of tibial plateau in Chinese. J Arthroplasty 15:224–227
Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation, scoring system. Clin Orthop Relat Res 248:9–12
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382
Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35:1443–1449
Jung KA, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine-tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:305–310
Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:373–377
Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86A:506–511
Hofmann AA, Bachus KN, Wyatt RW (1991) Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop Relat Res 269:63–69
Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467:2066–2072
Jenny JY, Rapp E, Kehr P (1997) Proximal tibial meniscal slope: a comparison with the bone slope. Rev Chir Orthop Reparatrice Appar Mot 84:435–438
Jiang CC, Yip KM, Liu TK (1994) Posterior slope angle of the medial tibial plateau. J Formos Med Assoc 93:509–512
Kessler MA, Burkart A, Martinek V, Beer A, Imhoff AB (2003) Development of a 3-dimensional method to determine the tibial slope with multislice-CT. Z Orthop Ihre Grenzgeb 141:143–147
Kuwano T, Urabe K, Miura H, Nagamine R, Matsuda S, Satomura M et al (2005) Importance of the lateral anatomic tibial slope as a guide to the tibial cut in total knee arthroplasty in Japanese patients. J Orthop Sci 10:42–47
Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K et al (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12:165–168
Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387
Papp M, Szabo L, Lazar I, Takacs I, Karolyi Z, Nagy GG, Vereb G (2009) Combined high tibial osteotomy decreases biomechanical changes radiologically detectable in the sagittal plane compared with closing-wedge osteotomy. Arthroscopy 25:355–364
Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13
Stulberg SD (2003) How accurate is current TKR instrumentation? Clin Orthop Relat Res 416:177–184
Whiteside LA, Amador DD (1988) The effect of posterior tibial slope on knee stability after Ortholoc total knee arthroplasty. J Arthroplasty 3(Suppl):S51–S57
Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK (2008) Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplasty 23:586–592
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Utzschneider, S., Goettinger, M., Weber, P. et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19, 1643–1648 (2011). https://doi.org/10.1007/s00167-011-1414-3
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DOI: https://doi.org/10.1007/s00167-011-1414-3