Iacono Francesco, Bonanzinga Tommaso, Di Matteo Berardo, Iacomella Alberto, Delmedico Michelangelo, Gambaro Francesco Manlio, Favaro Alberto, Marcacci Maurilio
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
J Clin Med. 2024 Jun 17;13(12):3548. doi: 10.3390/jcm13123548.
: In recent years, there has been considerable interest in prosthetic alignment techniques for total knee arthroplasty (TKA), particularly in the so-called kinematic alignment, which aims to restore the knee's native alignment. However, implementing this technique requires specialized instruments and procedural steps that can be laborious. This study introduces the bisector of the trochlear groove as a reliable landmark for performing the distal femoral cut while maintaining parallelism with the native femoral joint line. : Three orthopedic specialists assessed 110 X-ray images of full-leg, weight-bearing lower limbs obtained from healthy individuals between January 2021 and December 2022. The bisector of the trochlear groove was identified on the X-ray images, and the angle between this bisector and the femoral joint line was measured. The consistency of these measurements across repeated assessments and different examiners was evaluated. : The bisector of the trochlear groove was found to be perpendicular to the femoral joint line, with a mean angle of 89.4°. The inter-rater reliability was 68% within ±1.3° from the mean, while the intra-rater reliability was 82% within ±1.5° from the mean. : These results suggest that by performing a femoral cut perpendicular to the bisector of the trochlear groove, surgeons can inherently restore the femoral joint line of the native knee in patients where the native joint line is no longer identifiable due to the effect of osteoarthritis. This method may offer a viable and straightforward alternative to the standard surgical technique currently practiced for kinematic alignment in TKA.
近年来，全膝关节置换术（TKA）的假体对线技术引起了广泛关注，尤其是所谓的运动学对线，其目的是恢复膝关节的自然对线。然而，实施该技术需要专门的器械和繁琐的程序步骤。本研究引入滑车沟平分线作为一个可靠的标志，用于在进行股骨远端截骨时保持与自然股骨关节线平行。
三位骨科专家评估了2021年1月至2022年12月期间从健康个体获取的110张全腿负重下肢的X线图像。在X线图像上确定滑车沟平分线，并测量该平分线与股骨关节线之间的角度。评估了这些测量结果在重复评估和不同检查者之间的一致性。
发现滑车沟平分线与股骨关节线垂直，平均角度为89.4°。评分者间信度在平均角度±1.3°范围内为68%，而评分者内信度在平均角度±1.5°范围内为82%。
这些结果表明，通过垂直于滑车沟平分线进行股骨截骨，对于因骨关节炎影响而无法再识别自然关节线的患者，外科医生可以内在地恢复其天然膝关节的股骨关节线。该方法可能为目前TKA运动学对线的标准手术技术提供一种可行且直接的替代方案。
