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Bhagat SK, Regmi A, Niraula BB, Sah SP, Kunwar BB, Yadav R, Maheshwari V, Meena PK. Computed tomography-based morphometric analysis of normal distal tibiofibular syndesmosis in the Indian population. Foot Ankle Surg 2024:S1268-7731(24)00120-6. [PMID: 38851941 DOI: 10.1016/j.fas.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND In suspected Ankle Instability, the parameters that can be defined in the X-ray have their limitation owing to their variability in positioning and rotation of the tibiofibular joint. This inaccuracy further increases due to variability in morphometric parameters of distal tibiofibular syndesmosis among different populations based on race and sex. This research aims to study morphometry of normal distal tibiofibular syndesmosis based on computed tomography imaging in the Indian population. METHODS An Prospective observational study was performed from December 2020 to October 2022 on normal ankle CT scans of 100 Indian population using axial, sagittal, and coronal CT images. Anterior and posterior tibiofibular distance, Morphology of the incisura fibularis based on depth, Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO), Transverse and longitudinal length of the fibula, and Relationship between the center of the talus and the center of a line joining the outer aspect of malleoli in the coronal plane were measured and analyzed by two different observers. RESULTS Out of the 100 participants, 77 (77 %) were male, and 23 (23 %) were female. The overall mean age of participants was 34.69 ± 9.7 years. The incisura fibularis was concave in 54 %, and shallow in 46 %. Anterior tibiofibular distance, Posterior tibiofibular distance, and Tibiofibular overlap were significantly different in comparison to the male with female populations (p-value < 0.05). CONCLUSION This study gives the indices that describe normal variations in the anatomical relationship between the fibula and fibular incisure in the Indian population, which will be helpful for improving the diagnostic accuracy of distal tibiofibular syndesmoses and providing optimal treatment in order to improve functional outcomes and reduce the risk of complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Saroj Kumar Bhagat
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Anil Regmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Bishwa Bandhu Niraula
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Saroj Prasad Sah
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Bom Bahadur Kunwar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Robin Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Vikas Maheshwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
| | - Pradeep Kumar Meena
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
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Hernández-Hermoso JA, Nescolarde L, Yañez-Siller F, Calle-García J, Garcia-Perdomo D, Pérez-Andres R. Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome. J Orthop Traumatol 2023; 24:40. [PMID: 37535276 PMCID: PMC10400495 DOI: 10.1186/s10195-023-00718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different combined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. METHODS The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger's femoral angle (BFA)], three tibial [Berger's tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland-Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. RESULTS ATA showed the smaller inter- and intra-observer average of differences (-0.1° and 1.6°, respectively) of the studied methods followed by BFA (-0.9° and 1.4°), TE_PTCA (-2.1° and 2.7°) and BC_PTCA (-0.5° and 1.8°). BFA (-4° to 2.1° and -6.1° to 8.8°) and BC_PTCA (-4.4° to 3.4° and -7.9° to 4.4°) showed the narrower inter- and intra-observer limits of agreement. A TKA device rotation (BC_PTCA) < 0.8° of external rotation (ER) predicted a KSS and KSS knee successful outcome, and < 3.8° ER for KSS functional (AUC = 0.889; 0.907 and 0.764, respectively). BFA and ATA < 0.9° ER and < 3.9° internal rotation (IR) predicted a successful KSS knee outcome (AUC = 0.796 and 0.889, respectively). CONCLUSION The ATA tibial component rotation measurement was the most reliable of those studied. BFA, TE_PTCA and BC_PTCA were reliable measures for TKA femoral and combined rotation. The presence of a minimal rotation between the TKA components (BC_PTCA) and a small femoral ER or tibial IR predicted a successful KSS outcome. LEVEL OF EVIDENCE II
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Affiliation(s)
- José A Hernández-Hermoso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain.
- Department of Surgery, Faculty of medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain.
| | - Lexa Nescolarde
- Biomedical Engineering, Department of Electronic Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Federico Yañez-Siller
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Juan Calle-García
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Damian Garcia-Perdomo
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Ricard Pérez-Andres
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain
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Herregodts S, Vermue H, Herregodts J, De Coninck B, Chevalier A, Verstraete M, De Baets P, Victor J. Accuracy of intraoperative bone registration and stereotactic boundary reconstruction during total knee arthroplasty surgery. Int J Med Robot 2023; 19:e2460. [PMID: 36088533 DOI: 10.1002/rcs.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/30/2022] [Accepted: 09/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The intraoperative registration of the bones play a crucial role in image-based computer-assisted knee arthroplasty to achieve accurate implant placement and to create reliable stereotactic bone boundaries for robot-assisted surgical systems. METHOD This study assessed the intraoperative registration accuracy on six intact fresh frozen cadavers. RESULTS Rotational errors around the mechanical axis were the largest, with a standard deviation of 1.2° and outliers up to 3.7°. The mean translational errors were lower than 1 mm, with outliers up to 1.5 mm. These errors were amplified to 2 mm for the registration-based reconstruction of the posterior bone surface at the resection levels. CONCLUSION Given the cumulative behaviour of surgical errors, registration errors can affect the final implant positioning. Furthermore, inaccuracies in the reconstructed bone boundary directly affect the virtual stereotactic boundaries used in robotic-assisted surgery and can result in an incomplete resection or inadvertent soft tissue damage.
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Affiliation(s)
- Stijn Herregodts
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Electromechanical, Systems and Metals Engineering, Ghent University, Ghent, Belgium
| | - Hannes Vermue
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jan Herregodts
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Bert De Coninck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Amélie Chevalier
- Department of Electromechanical, Systems and Metals Engineering, Ghent University, Ghent, Belgium
| | | | - Patrick De Baets
- Department of Electromechanical, Systems and Metals Engineering, Ghent University, Ghent, Belgium
| | - Jan Victor
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Jang SJ, Kunze KN, Brilliant ZR, Henson M, Mayman DJ, Jerabek SA, Vigdorchik JM, Sculco PK. Comparison of tibial alignment parameters based on clinically relevant anatomical landmarks : a deep learning radiological analysis. Bone Jt Open 2022; 3:767-776. [PMID: 36196596 PMCID: PMC9626868 DOI: 10.1302/2633-1462.310.bjo-2022-0082.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AIMS Accurate identification of the ankle joint centre is critical for estimating tibial coronal alignment in total knee arthroplasty (TKA). The purpose of the current study was to leverage artificial intelligence (AI) to determine the accuracy and effect of using different radiological anatomical landmarks to quantify mechanical alignment in relation to a traditionally defined radiological ankle centre. METHODS Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A sub-cohort of 250 radiographs were annotated for landmarks relevant to knee alignment and used to train a deep learning (U-Net) workflow for angle calculation on the entire database. The radiological ankle centre was defined as the midpoint of the superior talus edge/tibial plafond. Knee alignment (hip-knee-ankle angle) was compared against 1) midpoint of the most prominent malleoli points, 2) midpoint of the soft-tissue overlying malleoli, and 3) midpoint of the soft-tissue sulcus above the malleoli. RESULTS A total of 932 bilateral full-limb radiographs (1,864 knees) were measured at a rate of 20.63 seconds/image. The knee alignment using the radiological ankle centre was accurate against ground truth radiologist measurements (inter-class correlation coefficient (ICC) = 0.99 (0.98 to 0.99)). Compared to the radiological ankle centre, the mean midpoint of the malleoli was 2.3 mm (SD 1.3) lateral and 5.2 mm (SD 2.4) distal, shifting alignment by 0.34o (SD 2.4o) valgus, whereas the midpoint of the soft-tissue sulcus was 4.69 mm (SD 3.55) lateral and 32.4 mm (SD 12.4) proximal, shifting alignment by 0.65o (SD 0.55o) valgus. On the intermalleolar line, measuring a point at 46% (SD 2%) of the intermalleolar width from the medial malleoli (2.38 mm medial adjustment from midpoint) resulted in knee alignment identical to using the radiological ankle centre. CONCLUSION The current study leveraged AI to create a consistent and objective model that can estimate patient-specific adjustments necessary for optimal landmark usage in extramedullary and computer-guided navigation for tibial coronal alignment to match radiological planning.Cite this article: Bone Jt Open 2022;3(10):767-776.
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Affiliation(s)
- Seong J. Jang
- Weill Cornell Medical College, New York, New York, USA,Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA,Correspondence should be sent to Seong Jun Jang. E-mail:
| | - Kyle N. Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Zachary R. Brilliant
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa Henson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - David J. Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Seth A. Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Peter K. Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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Correlation between Surface Area Ratio of Medial to Lateral Tibial Plateau and Knee Alignment in Adults. Curr Med Sci 2022; 42:577-583. [DOI: 10.1007/s11596-022-2590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/07/2022] [Indexed: 11/03/2022]
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Men J, Liang HG, Wang ZW, Sun P, Feng W. Efficacy Analysis of Selection of Distal Reference Point for Tibial Coronal Plane Osteotomy during Total Knee Arthroplasty: A Literature Review. Orthop Surg 2021; 13:1682-1693. [PMID: 34142453 PMCID: PMC8313145 DOI: 10.1111/os.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022] Open
Abstract
Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis. The tibial platform osteotomy must take full account of the coronal plane, the sagittal plane, and the rotational alignment of the tibial prosthesis. During surgery, individual differences in the coronal alignment of the tibia need to be taken into account as poor alignment after surgery can lead to rapid wear of the tibial platform, reducing the longevity of the prosthesis and adversely affecting quality of life. Intraoperative tibial osteotomies are often performed using extramedullary alignment. When an extramedullary alignment approach is used, the proximal tibial osteotomy guide is usually placed in the medial third of the tibial tuberosity. There is no consensus on the most reliable anatomical landmarks or axes for achieving distal tibial coronary alignment. Anatomical points or reference axes that are highly reproducible and precise need to be identified. From available data it appears that most surgeons use the extensor hallucis longus tendon, the second metatarsal, and the anterior tibial cortex to determine the distal localization point. However, its accuracy has not been confirmed in clinical and radiographic data, and the alignment concept and preoperative planning for total knee arthroplasty has paid more attention to rotational alignment, but there are few studies on the coronal alignment of the tibia. This article reviews the recent use of the distal tibial coronal osteotomy reference point in total knee arthroplasty. However, due to there being only a small number of studies available, the evidence collected is insufficient to prove that a certain reference axis has obvious advantages and a combination of different reference points is needed to achieve the ideal lower extremity force line angle.
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Affiliation(s)
- Jie Men
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Han-Guang Liang
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Zhi-Wei Wang
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Peng Sun
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Wei Feng
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
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