Determination of knee joint line in relation to bony landmarks: a CT study in Turkish population

Yıl 2022, Cilt: 16 Sayı: 2, 81 - 87, 30.08.2022

Cem Özcan Ali Şahin

Öz

Objectives: Evaluation of the knee joint line is important in terms of clinical outcomes in lower extremity alignment surgeries. Since there are a limited number of studies examining the relationship between the normal knee joint line and the bony landmarks around the knee in Turkish society, we evaluated the relationship between the knee joint line and the bone landmarks in the Turkish population.
Methods: Knee CT images of 100 patients (50 females, 50 males) aged between 18−50 years were retrospectively evaluated. The distance between the joint line and the medial epicondyle, lateral epicondyle, apex of head of fibula, patella lower pole, tuberositas tibia and interepicondylar distance of the femur was evaluated.
Results: With the exception of lateral epicondyle/femoral transepicondylar width, tibial tubercle distance/femoral transepicondylar width, tibial width /femoral transepicondylar width, and tibial width/tibial tubercle distance; all ratios differed between the genders with statistical significance (p<0.005).
Conclusion: CT evaluation of the knee joint allows making precise measurements in the coronal, axial and sagittal planes. We believe that the values we determined will help surgeons to determine the joint line during total knee replacement and revision knee replacement surgery in Turkish patients.

Anahtar Kelimeler

bony landmarks, femoral interepicondylar width, knee, knee joint line

Kaynakça

• Clave A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F. Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. Int Orthop 2016;40:1655–62.
• Martin JW, Whiteside LA. The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 1990;(259):146–56.
• Singerman R, Heiple KG, Davy DT, Goldberg VM. Effect of tibial component position on patellar strain following total knee arthroplasty. J Arthroplast 1995;10:651–6.
• Fornalski S, McGarry MH, Bui CN, Kim WC, Lee TQ. Biomechanical effects of joint line elevation in total knee arthroplasty. Clin Biomech 2012;27:824–9.
• Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 1999;(367):165–71.
• Khan WS, Bhamra J, Williams R, Morgan-Jones R. “Meniscal” scar as a landmark for the joint line in revision total knee replacement. World J Orthop 2017;8:57–61.
• Griffin FM, Math K, Scuderi GR, Insall JN, Polivache PL. Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 2000;15:354–9.
• Servien E, Viskontas D, Giuffre BM, Coolican MRJ, Parker DA. Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008;16:263–9.
• Fan A, Xu T, Li X, Lei L, Fan L, Yang D, Li G. Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study. J Orthop Surg Res 2018;13:261–70.
• Pereira GC, von Kaeppler E, Alaia MJ, Montini K, Lopez MJ, Di Cesare PE, Amanatullah DF. Calculating the position of the joint line of the knee using anatomical landmarks. Orthopedics 2016;39:381–6.
• Ozkurt B, Sen T, Cankaya D, Kendir S, Basarir K, Tabak Y. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–6.
• Gurbuz H, Cakar M, Adas M, Tekin AC, Bayraktar MK, Esenyel CZ. Measurement of the knee joint line in Turkish population. Acta Orthop Traumatol Turc 2015;49:41–4.
• Laskin RS. Management of the patella during revision total knee replacement arthroplasty. Orthop Clin North Am 1998;29:355–60.
• Laskin RS. Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 2002;(404):169–71.
• König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO. Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 2010;28:1–5.y
• Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T. The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 2014;134:537–41.
• Rajagopal TS, Nathwani D. Can interepicondylar distance predict joint line position in primary and revision knee arthroplasty? Am J Orthop (Belle Mead NJ) 2011;40:175–8.
• Sadaka C, Kabalan Z, Hoyek F, Abi Fares G, Lahoud JC. Joint line restoration during revision total knee arthroplasty: an accurate and reliable method. SpringerPlus 2015;4:736.
• Romero J, Seifert B, Reinhardt O, Ziegler O, Kessler O. A useful radiologic method for preoperative joint-line determination in revision total knee arthroplasty. Clin Orthop Relat Res 2010;468:1279–83.
• Lee IS, Choi JA, Kim TK, Han I, Lee JW, Kang HS. Reliability analysis of 16-MDCT in preoperative evaluation of total knee arthroplasty and comparison with intraoperative measurements. AJR Am J Roentgenol 2006;186:1778–82.
• Seedhom BB, Longton EB, Wright V, Dowson D. Dimensions of the knee. Radiographic and autopsy study of sizes required by a knee prosthesis. Ann Rheum Dis 1972;31:54–8.
• Iacono F, Lo Presti ML, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci. The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 2013;21:2725–9.
• Mason M, Belisle A, Bonutti P. An accurate and reproducible method for locating the joint line during a revision total knee arthroplasty. J Arthroplasty 2006;21:1147–53.
• Sato T, Koga Y, Sobue T, Omori G, Tanabe Y, Sakamoto M. Quantitative 3-dimensional analysis of preoperative and postoperative joint lines in total knee arthroplasty: a new concept for evaluation of component alignment. J Arthroplasty 2007;22:560–8.
• Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013;21:2288–95.
• Herzog RJ, Silliman JF, Hutton K, Rodkey WG, Steadman JR. Measurements of the intercondylar notch by plain film radiography and magnetic resonance imaging. Am J Sports Med 1994;22:204–10.