J Korean Orthop Assoc.  2007 Jun;42(3):345-353. 10.4055/jkoa.2007.42.3.345.

Three Dimensional Analysis for the Intramedullary Canal Axis of the Proximal Tibia: Clinical Relevance to Total Knee Arthroplasty

• Song SJ
• Choi CH

• KMID: 2186559
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.345

Abstract

PURPOSE: To evaluate the appropriate entry point of an intramedullary tibial cutting guide in total knee arthroplasty in Koreans by measuring the "intramedullary canal axis" of the proximal tibia in three dimensions.
MATERIALS AND METHODS
Computed tomography was performed on 116 lower extremities from the hip to the ankle on 58 Korean cadavers. A three dimensional image of the tibia was reconstructed using the program, Bionix version 3.3. The location of intramedullary canal axis of proximal tibia passing through tibial plateau, canal axis center 1 (CAC 1), was measured. The beta' angle was defined as the angle between the tibial anatomical axis and a line perpendicular to the knee joint line. The correlations between the beta' angle and the CAC 1 mediolateral coordinates were analyzed.
RESULTS
The CAC 1 is located on 56.3% from the medial cortex and 27.8% from the anterior cortex on the average. On average, the CAC 1 was located 1.2 mm medially and 15.9 mm anteriorly from the lateral tibial spine 1. The beta' angles and medial-lateral coordinates of the CAC 1 showed a significant positive correlation (r=0.418, p=0.000).
CONCLUSION
When using an intramedullary guide for tibial cutting in total knee arthroplasty in Koreans, the entry point at the lateral and anterior positions from the surface center of the tibial plateau is appropriate. The lateralization of the entry point of intramedullary tibial cutting guide becomes necessary as the varus of the tibia becomes more severe. Because of the marked variability in the CAC 1, a preoperative evaluation of the CAC 1 needs to be carried out in order to properly locate the appropriate entry point of the intramedullary tibial cutting guide in total knee arthroplasty.

Keyword

Tibia; Intramedullary canal axis; 3D computed tomography; Total knee arthroplasty

MeSH Terms

Ankle
Arthroplasty*
Axis, Cervical Vertebra*
Cadaver
Hip
Imaging, Three-Dimensional
Knee Joint
Knee*
Lower Extremity
Spine
Tibia*

Figure

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  Fig. 1 The surface involving the transepicondylar axis is projected in the superior perspective of the tibial plateau and in the imaginary cut surface 10 mm below the lateral tibial plateau.

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  Fig. 2 Measured morphological parameters on the tibial plateau in the superior perspective. CAC 1, Canal axis center 1, is the location of intramedullary canal axis of the proximal tibia passing through the tibial plateau. LTS 1 is the location of the lateral tibial spine. SC 1, Surface center 1, is the anteroposterior and mediolateral center on the tibial plateau.

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  Fig. 3 Measured morphological parameters on the imaginary cut surface, 10 mm below the lateral tibial plateau in the superior perspective. CAC 2, Canal axis center 2, is the location of the intramedullary canal axis of the proximal tibia passing through an imaginary cut surface. SC 2, Surface center 2, is the anteroposterior and mediolateral center.

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  Fig. 4 Mathematically calculated canal axis center. The canal axis center was calculated using a least-squares fit to describe a line through the centroids.

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  Fig. 5 Correlation between the β' angles and the CAC 1 mediolateral coordinates.

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  Fig. 6 Correlation between the β' angles and the CAC 2 mediolateral coordinates.

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