Purpose: Although the tibial rotation axis is significant in knee arthroplasty, no reliable extraarticular landmark has been proposed. We hypothesized that the tibial lateral axis (TLA), a tangential line of the lateral tibial surface, is perpendicular to the surgical epicondylar axis (SEA) and compared it to other existing landmarks by 3D-CT.
Methods: Fifty legs in 25 consecutive patients were studied. Using their preoperative CT, the TLAs were identified on slices at 10-50% of the total length of the tibia and the measured differences of angles against the line perpendicular to the SEA (the tibial AP axis) were calculated. The differences between the SEA and the femoral and tibial posterior condylar axis, Akagi's line and the line between the medial intercondylar spine and the medial border of the patellar tendon (sAP line)(intraarticular), the ankle axis, and the transmalleolar axis (extraarticular) were also calculated and compared.
Results: The mean values of TLA at 10%, 20%, 30% were virtually parallel to the SEA (0.97° ± 4.84°, 0.02° ± 4.61°, 1.10° ± 4.97°, respectively). They were equivalent to existing intraarticular landmarks and superior to existing extraarticular landmarks, and these levels corresponded to the tip to the lower end of the tibial tubercle (at 10.8% and 17.0% of total tibial length).
Conclusion: The proximal TLAs can be an extraarticular bony landmark that indicates the line perpendicular to the SEA. A prospective study is needed to prove the validity and accuracy of the axes clinically.
Keywords: Anatomy; Anteroposterior axis; Bony Landmark; Knee arthroplasty.