Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component
Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component
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DOI：
10.1007/s00167-013-2468-1
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发表时间：
2014-05-01
影响因子：
3.8
通讯作者：
Iwamoto, Yukihide
中科院分区：
文献类型：
--
作者：
Kawahara, Shinya;Okazaki, Ken;Iwamoto, Yukihide
连接后十字韧带中部与附着处髌腱内侧缘的前后 (AP) 轴已被引入作为垂直于健康膝关节手术上髁轴的可重复且可靠的参考。最近的一篇文献报道，平均而言，在内翻和外翻膝中，胫骨的 AP 轴几乎垂直于手术上髁轴，并且可以用作胫骨旋转参考，以最大限度地减少全膝关节置换术 (TKA) 中股骨和胫骨组件之间旋转不匹配的风险。然而，胫骨切除后很难识别AP轴。本研究的目的是确定修改后的 AP 轴，该轴与骨关节炎膝关节中的 AP 轴平行并穿过切面中心。使用三维软件对 30 个内翻和 30 个外翻膝关节进行 TKA 时进行术前计算机断层扫描进行研究。绘制与 AP 轴平行并穿过切割面中心的修改后的 AP 轴。我们研究了改良后的AP轴在胫骨附着处与髌腱的交叉位置。在内翻和外翻膝中，改良后的AP轴在其附着处穿过髌腱的内侧1/6（距内侧边缘4毫米）。胫骨的AP轴在切割近端胫骨时可用作胫骨旋转参考，但胫骨切除后很难识别AP轴。这项研究的临床相关性是，髌腱附着处的内侧 1/6 将成为对齐胫骨组件的有用标志。
The anteroposterior (AP) axis connecting the middle of the posterior cruciate ligament to the medial border of the patellar tendon at its attachment has been introduced as a reproducible and reliable reference perpendicular to the surgical epicondylar axis in healthy knees. A recent literature has reported that the AP axis of the tibia is, on average, almost perpendicular to the surgical epicondylar axis also in varus and valgus knees and can be used as a tibial rotational reference to minimize the risk for rotational mismatch between the femoral and tibial components in total knee arthroplasty (TKA). However, it is difficult to identify the AP axis after tibial resection. The purpose of the current study was to determine a modified AP axis that runs parallel to the AP axis and passes through the centre of the cut surface in osteoarthritic knees.Preoperative computed tomography scans on 30 varus and 30 valgus knees undergoing TKA were studied using a three-dimensional software. The modified AP axis that runs parallel to the AP axis and passes through the centre of the cut surface was drawn. We investigated where the modified AP axis crossed the patellar tendon at its tibial attachment.The modified AP axis passed through the medial 1/6 of the patellar tendon (4 mm from medial edge) at its attachment in both varus and valgus knees.The AP axis of the tibia is useful as a tibial rotational reference in cutting the proximal tibia, but it is difficult to identify the AP axis after tibial resection. The clinical relevance of this study is that medial 1/6 of the patellar tendon at its attachment would be a useful landmark in aligning the tibial component.IV.