Tibial component considerations in bicruciate-retaining total knee arthroplasty

A 3D MRI evaluation of proximal tibial anatomy

Vishal Saxena, Jason B. Anari, Alexander T. Ruutiainen, Pramod B. Voleti, Jason W. Stephenson, Gwo Chin Lee

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. Methods We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. Results There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95% CI 5.0 to 6.0°) vs. 5.4° (95% CI 4.8 to 6.0°), respectively (p = 0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95% CI 4.0 to 5.1°) vs. 3.3° (95% CI 2.9 to 3.7°), respectively (p < 0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8 mm (95% CI 10.4 to 11.2 mm) vs. 13.0 mm (95% CI 12.5 to 13.5 mm), respectively (p < 0.0001)). Conclusions Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. Level of Evidence Level IV - Anatomic research study.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalKnee
Volume23
Issue number4
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Fingerprint

Knee Replacement Arthroplasties
Tibia
Anatomy
Knee
Ligaments
Biomechanical Phenomena
Arthritis
Research

Keywords

  • Bicruciate-retaining
  • MRI
  • Tibial slope
  • TKA

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Tibial component considerations in bicruciate-retaining total knee arthroplasty : A 3D MRI evaluation of proximal tibial anatomy. / Saxena, Vishal; Anari, Jason B.; Ruutiainen, Alexander T.; Voleti, Pramod B.; Stephenson, Jason W.; Lee, Gwo Chin.

In: Knee, Vol. 23, No. 4, 01.08.2016, p. 593-599.

Research output: Contribution to journalArticle

Saxena, Vishal ; Anari, Jason B. ; Ruutiainen, Alexander T. ; Voleti, Pramod B. ; Stephenson, Jason W. ; Lee, Gwo Chin. / Tibial component considerations in bicruciate-retaining total knee arthroplasty : A 3D MRI evaluation of proximal tibial anatomy. In: Knee. 2016 ; Vol. 23, No. 4. pp. 593-599.
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abstract = "Background Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. Methods We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. Results There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95{\%} CI 5.0 to 6.0°) vs. 5.4° (95{\%} CI 4.8 to 6.0°), respectively (p = 0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95{\%} CI 4.0 to 5.1°) vs. 3.3° (95{\%} CI 2.9 to 3.7°), respectively (p < 0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8 mm (95{\%} CI 10.4 to 11.2 mm) vs. 13.0 mm (95{\%} CI 12.5 to 13.5 mm), respectively (p < 0.0001)). Conclusions Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. Level of Evidence Level IV - Anatomic research study.",
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AU - Voleti, Pramod B.

AU - Stephenson, Jason W.

AU - Lee, Gwo Chin

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N2 - Background Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. Methods We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. Results There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95% CI 5.0 to 6.0°) vs. 5.4° (95% CI 4.8 to 6.0°), respectively (p = 0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95% CI 4.0 to 5.1°) vs. 3.3° (95% CI 2.9 to 3.7°), respectively (p < 0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8 mm (95% CI 10.4 to 11.2 mm) vs. 13.0 mm (95% CI 12.5 to 13.5 mm), respectively (p < 0.0001)). Conclusions Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. Level of Evidence Level IV - Anatomic research study.

AB - Background Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. Methods We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. Results There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95% CI 5.0 to 6.0°) vs. 5.4° (95% CI 4.8 to 6.0°), respectively (p = 0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95% CI 4.0 to 5.1°) vs. 3.3° (95% CI 2.9 to 3.7°), respectively (p < 0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8 mm (95% CI 10.4 to 11.2 mm) vs. 13.0 mm (95% CI 12.5 to 13.5 mm), respectively (p < 0.0001)). Conclusions Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. Level of Evidence Level IV - Anatomic research study.

KW - Bicruciate-retaining

KW - MRI

KW - Tibial slope

KW - TKA

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