Yüksel Yüksel, Akar Mehmet Sait
Karşıyaka State Hospital, Department of Orthopedics and Traumatology, Adana, Turkey.
Dicle University Faculty of Medicine, Department of Orthopedics and Traumatology, Diyarbakır, Turkey.
Arch Orthop Trauma Surg. 2025 Aug 12;145(1):407. doi: 10.1007/s00402-025-06031-3.
Accurate anatomical determination of the knee joint line is critically important for the success of both primary and revision total knee arthroplasty procedures. This study aimed to evaluate the reliability of anatomical landmarks for determining the knee joint line using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the Turkish population.
This retrospective study included 186 patients. Anatomical reference points for the knee joint line were defined as the adductor tubercle, medial and lateral epicondyles, fibular head, tibial tuberosity, and inferior pole of the patella. Measurements obtained from all three imaging modalities were compared, and the relationships between femoral width (FW) and reference points were analyzed using correlation and linear regression analyses.
No statistically significant differences were found between the measurement results of the reference points across the imaging methods (lowest r = 0.91, p < 0.001). A strong correlation was observed between FW and the adductor tubercle joint line (ATJL) and medial epicondyle joint line (MEJL). Intraclass correlation coefficients (ICC) were greater than 0.90, indicating excellent reliability.
The adductor tubercle was identified as a reliable anatomical landmark for determining the knee joint line. Additionally, plain radiography, which offers advantages in terms of cost and reduced radiation exposure, may be a sufficient alternative for clinical applications. These findings can provide valuable contributions to surgical planning for accurate joint line determination. However, further studies are needed to validate these results in patients requiring surgical intervention.
准确解剖确定膝关节线对于初次和翻修全膝关节置换手术的成功至关重要。本研究旨在评估在土耳其人群中使用X线平片、计算机断层扫描（CT）和磁共振成像（MRI）确定膝关节线的解剖标志的可靠性。
这项回顾性研究纳入了186例患者。膝关节线的解剖参考点定义为内收肌结节、内外侧髁、腓骨头、胫骨结节和髌骨下极。比较了从所有三种成像方式获得的测量结果，并使用相关性和线性回归分析分析了股骨宽度（FW）与参考点之间的关系。
各成像方法的参考点测量结果之间未发现统计学显著差异（最低r = 0.91，p < 0.001）。观察到FW与内收肌结节关节线（ATJL）和内侧髁关节线（MEJL）之间存在强相关性。组内相关系数（ICC）大于0.90，表明可靠性极佳。
内收肌结节被确定为确定膝关节线的可靠解剖标志。此外，在成本和减少辐射暴露方面具有优势的X线平片可能是临床应用的充分替代方法。这些发现可为准确确定关节线的手术规划提供有价值的贡献。然而，需要进一步研究在需要手术干预的患者中验证这些结果。
