The Definition of the Tibial Sagittal Plane and the Paradox of Imageless Navigation and Robotics: A Cadaveric Study

Hannes Vermue; Lenka Stroobant; Lauren Pringels; Amélie Chevalier; Jan Victor

doi:10.1016/j.arth.2023.02.039

The Definition of the Tibial Sagittal Plane and the Paradox of Imageless Navigation and Robotics: A Cadaveric Study

J Arthroplasty. 2023 Jun;38(6S):S374-S378. doi: 10.1016/j.arth.2023.02.039. Epub 2023 Feb 22.

Authors

Hannes Vermue¹, Lenka Stroobant¹, Lauren Pringels², Amélie Chevalier³, Jan Victor¹

Affiliations

¹ Department of Orthopedic Surgery, University Hospital Ghent, Gent, Belgium.
² Department of Physical Medicine and Rehabilitation, University Hospital Ghent, Gent, Belgium.
³ Department of Electromechanical, Systems and Metal Engineering, Ghent University, Gent, Belgium.

PMID: 36828051
DOI: 10.1016/j.arth.2023.02.039

Abstract

Background: The accuracy, precision, and repeatability by which the tibial sagittal plane can be found with imageless technology is currently unknown. The purpose of this study was to identify any differences between imageless and image-based technology to define the sagittal plane of the tibia.

Methods: A computed tomography (CT) was obtained of 18 cadavers with the knee fully extended. The surgical trans-epicondylar axis and several tibial rotation references were acquired on the CT scan. After a medial parapatellar approach, the same anatomical landmarks were acquired in vivo. In the horizontal plane, the angle between the surgical trans-epicondylar axis and the tibial rotational axes was assessed.

Results: Highest accuracy was found for posterior cruciate ligament (PCL)-anterior cruciate ligament (ACL, -1.48°, standard deviation [SD] 13.64; imageless), tibial medial condyle (TMC)-tibial lateral condyle (TLC, 1.72°, SD 4.24; image-based), the ACL-medial border of tibial tuberosity (MTT, -2.89°, SD 18.86; image-based). Highest precision was acquired with image-based technology: TMC-TLC (SD 4.24), PCL-ACL (SD 5.86), and PCL-medial third of tibial tuberosity (M3TT, SD 7.10). Excellent intraobserver and interobserver correlation coefficients were observed with image-based technology: PCL-MTT, anterior medial condyle (AMC)-anterior lateral condyle (ALC), and TMC-TLC (Intraobserver and interobserver correlation coefficients 0.90-0.98).

Conclusion: The tibial sagittal plane could be defined with highest accuracy, precision, and repeatability on a preoperative CT. Imageless methodology lacked the precision and repeatability of image-based technology. With the current pursuit of high accuracy and precision in total knee arthroplasty, the reference frame used to quantify implant position should be highly accurate and precise as well.

Level of evidence: IV, Case Series.

Keywords: image-based; imageless; robotics; surgical navigation; tibial rotation; total knee arthroplasty.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anterior Cruciate Ligament / surgery
Cadaver
Humans
Knee Joint / diagnostic imaging
Knee Joint / surgery
Posterior Cruciate Ligament*
Tibia* / diagnostic imaging
Tibia* / surgery