Di Matteo Berardo, Altomare Daniele, Dorotei Andrea, Raspugli Giovanni Francesco, Bonanzinga Tommaso, Marcacci Maurilio, Kon Elizaveta, Iacono Francesco
Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
Ann Transl Med. 2021 Jan;9(1):71. doi: 10.21037/atm-20-3681.
Joint line (JL) restoration is one of the major challenges in revision total knee arthroplasty (rTKA). There is debate regarding the most reliable methodology for the assessment of JL level during revision surgery. Among the strategies, the use of adductor tubercle (AT) as an anatomical landmark has been proposed. The purpose of this paper is to systematically review the available literature to understand the reliability of AT ratio to identify the JL, and the advantages and drawbacks of its application. A research was performed on the PubMed, Embase, Cochrane and Google Scholar databases based on the following inclusion criteria for articles' selection: (I) clinical reports of any level of evidence, (II) written in the English language, (III) published from 2010 to 2020, (IV) dealing with the use of the adductor tubercle as a landmark to restore JL in revision TKA. All relevant data were extracted by two independent investigators, and discrepancies were resolved by discussion and consensus. A total of 13 studies were included: nine were radiographic evaluations, 3 clinical reports and 1 was an ex-vivo study. Radiographic studies highlighted that AT is a landmark easy to identify, with high intra and inter-observer agreement, irrespective of gender, age and size of the patient. The comparison with other bony landmarks revealed superior reliability in favor of AT. Also during surgical procedures, AT can be safely located and some clinical studies confirmed that AT ratio helps surgeon in re-establishing a correct JL and achieve ligament balancing even in complex revision cases. AT is a reliable and easily detectable landmark, and AT ratio is a valid tool to determine the JL level and help surgeons to restore the JL and simultaneously achieve knee ligament balancing in r-TKA.
关节线（JL）重建是翻修全膝关节置换术（rTKA）中的主要挑战之一。关于翻修手术中评估JL水平的最可靠方法存在争议。在这些策略中，有人提出使用内收肌结节（AT）作为解剖标志。本文的目的是系统回顾现有文献，以了解AT比率识别JL的可靠性及其应用的优缺点。基于以下文章选择纳入标准，对PubMed、Embase、Cochrane和谷歌学术数据库进行了检索：（I）任何证据水平的临床报告；（II）英文撰写；（III）2010年至2020年发表；（IV）涉及在翻修TKA中使用内收肌结节作为恢复JL的标志。所有相关数据由两名独立研究人员提取，差异通过讨论和协商解决。共纳入13项研究：9项为影像学评估，3项为临床报告，1项为体外研究。影像学研究表明，AT是一个易于识别的标志，观察者内和观察者间一致性高，与患者的性别、年龄和体型无关。与其他骨性标志相比，AT具有更高的可靠性。在手术过程中，也可以安全地定位AT，一些临床研究证实，即使在复杂的翻修病例中，AT比率也有助于外科医生重新建立正确的JL并实现韧带平衡。AT是一个可靠且易于检测的标志，AT比率是确定JL水平的有效工具，有助于外科医生在r-TKA中恢复JL并同时实现膝关节韧带平衡。
