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The tibial spine sign does not indicate cartilage damage in the central area of the distal lateral femoral condyle

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A radiographic overlap of the lateral femoral condyle and the lateral tibial spine (‘tibial spine sign’) might indicate lateral compartment cartilage damage and might be considered a contraindication for unicompartmental knee arthroplasty (UKA). Therefore, the following research questions were asked: (1) does the presence of a ‘tibial spine sign’ on radiographs correlate with cartilage lesions on the medial aspect of the lateral femoral condyle on corresponding MRIs?; (2) do cartilage lesions on the medial aspect of the lateral femoral condyle indicate cartilage damage in the central area of the distal lateral femur?; and 3) is the ‘tibial spine sign’ impacted by the degree of varus deformity, the amount of coronal tibiofemoral subluxation or the functional status of the ACL?

Methods

One hundred consecutive knees with varus OA in 84 patients were prospectively included. The relationship of the lateral femoral condyle and the tibial spine was graded from 0 to 2 based on the degree of overlap on AP standing knee radiographs. On MRI, cartilage on the medial aspect of the lateral femoral condyle was assessed. Cartilage in the weight-bearing area of the distal lateral femur was analysed according to the OARSI system.

Results

The ‘tibial spine sign’ assessment correlated well with the degree of cartilage damage on the medial aspect of the lateral condyle (rs = 0.7, p < 0.001) but did not impact histological OARSI grades in the central weight bearing area of the lateral condyle (n.s.). Mechanical varus and tibiofemoral subluxation were not associated (n.s.) with a positive tibial spine sign. Knees with suggestive ACL insufficiency on MRI had more often a positive tibial spine sign; however, this difference was not statistically significant (n.s.).

Conclusion

A positive tibial spine sign does not indicate histologic cartilage damage in the central area of the distal lateral femur and may not be considered a contraindication for medial UKA.

Level of evidence

Level III, diagnostic study.

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References

  1. Goodfellow J (2006) Unicompartmental arthroplasty with the Oxford knee. Oxford University Press, Oxford

    Google Scholar 

  2. Hovis KK, Alizai H, Tham SC, Souza RB, Nevitt MC, McCulloch CE et al (2012) Non-traumatic anterior cruciate ligament abnormalities and their relationship to osteoarthritis using morphological grading and cartilage T2 relaxation times: data from the Osteoarthritis Initiative (OAI). Skeletal Radiol 41:1435–1443

    Article  Google Scholar 

  3. ICRS Cartilage Injury Evaluation Package 2000. https://cartilage.org/content/uploads/2014/10/ICRS_evaluation.pdf

  4. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  Google Scholar 

  5. Kendrick BJ, Rout R, Bottomley NJ, Pandit H, Gill HS, Price AJ et al (2010) The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. J Bone Joint Surg Br 92:374–379

    Article  CAS  Google Scholar 

  6. Kwon HM, Kang KT, Kim JH, Park KK (2019) Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outcomes. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05636-7

    Article  PubMed  Google Scholar 

  7. Mancuso F, Dodd CA, Murray DW, Pandit H (2016) Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 17:267–275

    Article  Google Scholar 

  8. Murray DW, Liddle AD, Dodd CA, Pandit H (2015) Unicompartmental knee arthroplasty: is the glass half full or half empty? Bone Joint J 97-B:3–8

  9. Nam D, Khamaisy S, Gladnick BP, Paul S, Pearle AD (2013) Is tibiofemoral subluxation correctable in unicompartmental knee arthroplasty? J Arthroplasty 28:1575–1579

    Article  Google Scholar 

  10. Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB (1998) Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 80:1276–1284

    Article  CAS  Google Scholar 

  11. Pritzker KP, Gay S, Jimenez SA, Ostergaard K, Pelletier JP, Revell PA et al (2006) Osteoarthritis cartilage histopathology: grading and staging. Osteoarthritis Cartilage 14:13–29

    Article  CAS  Google Scholar 

  12. Richmond JC (2013) Surgery for osteoarthritis of the knee. Rheum Dis Clin North Am 39:203–211

    Article  Google Scholar 

  13. Schnaiter JW, Roemer F, McKenna-Kuettner A, Patzak HJ, May MS, Janka R et al (2018) Diagnostic accuracy of an MRI protocol of the knee accelerated through parallel imaging in correlation to arthroscopy. Rofo 190:265–272

    Article  Google Scholar 

  14. Vainionpaa S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study. J Bone Joint Surg Am 63:938–946

    Article  CAS  Google Scholar 

  15. Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM et al (2012) Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 20:256–261

    Article  Google Scholar 

  16. Waldstein W, Bou Monsef J, Buckup J, Boettner F (2013) The value of valgus stress radiographs in the workup for medial unicompartmental arthritis. Clin Orthop Relat Res 471:3998–4003

    Article  Google Scholar 

  17. Waldstein W, Merle C, Monsef JB, Boettner F (2015) Varus knee osteoarthritis: how can we identify ACL insufficiency? Knee Surg Sports Traumatol Arthrosc 23:2178–2184

    Article  Google Scholar 

  18. Waldstein W, Perino G, Gilbert SL, Maher SA, Windhager R, Boettner F (2016) OARSI osteoarthritis cartilage histopathology assessment system: a biomechanical evaluation in the human knee. J Orthop Res 34:135–140

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, 10021, USA

    Friedrich Boettner

  2. Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

    Bernhard Springer, Reinhard Windhager & Wenzel Waldstein

Authors
  1. Friedrich Boettner
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  2. Bernhard Springer
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  3. Reinhard Windhager
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  4. Wenzel Waldstein
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Contributions

WW and FB prepared the manuscript and coordinated to the study. BS performed the statistical analysis and radiographic assessments. RW made substantial contributions to the conception of the manuscript and the interpretation of data. FB conceived of the study and was responsible for the study design and the inclusion of patients. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Friedrich Boettner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The institution of the authors has received funding from Smith & Nephew Inc (Memphis, TN, USA).

Ethical approval

The study was approved by the institutional ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All patients gave informed consent prior to inclusion in the study.

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Boettner, F., Springer, B., Windhager, R. et al. The tibial spine sign does not indicate cartilage damage in the central area of the distal lateral femoral condyle. Knee Surg Sports Traumatol Arthrosc 28, 2592–2597 (2020). https://doi.org/10.1007/s00167-020-05881-1

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  • DOI: https://doi.org/10.1007/s00167-020-05881-1

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