Mapping of the anterior tibial profile to identify accurate reference points for sagittal alignment of tibial component in total knee arthroplasty

BACKGROUND: Although standard instrumentation is the procedure most frequently used to implant a Total Knee Arthroplasty (TKA), high rates of malalignment of tibial component are reported using this technique. Anatomical landmarks for sagittal alignment have been little investigated and the best reference axis, which parallels the mechanical axis, is yet to be established. HYPOTHESIS: Mapping the Anterior Tibial Profile (ATP) may allow the identification of segmental zones of the ATP parallel to the mechanical axis which can be used to align the extramedullary rod. METHODS: An intramedullary rod was positioned in line with the mechanical axis in 47 dried cadaveric tibiae. The rod was connected to a cutting jig and to an extramedullary rod. Digitalized images of lateral view radiographs were taken and the distance between the ATP and the extramedullary rod was measured at 10-mm intervals and at interpolated distances corresponding to every 2% of the tibial length. RESULTS: Segmental portions of the ATP exhibit an alignment parallel to the mechanical axis between points located at 58% and 90% and at 62% and 88% of the tibial length. Points placed at 50% of tibial length and 5mm proximal to the ankle joint generate the longer axis parallel to the mechanical axis. CONCLUSION: The orientation of sagittal tibial cut may be improved by aligning the extramedullary rod parallel to the ATP at definite points. Points placed at 50% of the tibial length and 5mm proximal to the ankle joint may be preferred since they generate the longer axis parallel to the mechanical axis and are more easily identified at surgery.