Skip to main content
SpringerLink
Log in

Variations in medial and lateral slope and medial proximal tibial angle

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The primary objective of this study was to quantify the variations of the medial posterior tibial slope (MPTS) and the lateral posterior tibial slope (LPTS), as well as of the medial proximal tibial angle (MPTA), and to determine the fraction of patients for which standard techniques including different alignment techniques would result in alteration of the patient’s individual posterior tibial slope (PTS) and MPTA. Furthermore, it was of interest if a positive correlation between PTS and MPTA or between medial and lateral slope exists.

Methods

A retrospective study was performed on CT-scans of 234 consecutively selected European patients undergoing individual total knee replacement. All measurements were done on three-dimensional CAD models, which were generated on the basis of individual CT-scans, including the hip, knee, and ankle center. Measurements included the medial and lateral PTS and the MPTA. PTS was measured as the angle between the patient’s articular surface and a plane perpendicular to the mechanical axis of the tibia in the sagittal plane. MPTA was defined as the angle between the tibial mechanical axis and the proximal articular surface of the tibia in the coronal plane.

Results

Analysis revealed a wide variation of the MPTS, LPTS, and MPTA among the patients. MPTS and LPTS varied significantly both interindividually and intraindividually. The range of PTS was up to 20° for MPTS (from − 4.3° to 16.8°) and for LPTS (from − 2.9 to 17.2°). The mean intraindividual difference between MPTS and LPTS in the same knee was 2.6° (SD 2.0) with a maximum of 9.5°. MPTA ranged from 79.8 to 92.1° with a mean of 86.6° (SD ± 2.4). Statistical analysis revealed a weak positive correlation between MPTA and MPTS.

Conclusion

The study demonstrates a huge interindividual variability in PTS and MPTA as well as significant intraindividual differences in MPTS and LPTS. Therefore, the question arises, whether the use of standard techniques, including fixed PTSs and MPTAs, is sufficient to address every single patient’s individual anatomy.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

PTS:

Posterior tibial slope

MPTS:

Medial posterior tibial slope

LPTS:

Lateral posterior tibial slope

MPTA:

Medial proximal tibial angle

TKA:

Total knee arthroplasty

UKA:

Unicondylar knee arthroplasty

References

  1. Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:193–196

    Article  CAS  Google Scholar 

  2. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  Google Scholar 

  3. Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Jt J 96:907–913

    Article  Google Scholar 

  4. Haddad B, Konan S, Mannan K, Scott G (2012) Evaluation of the posterior tibial slope on MR images in different population groups using the tibial proximal anatomical axis. Acta Orthop Belg 78:757–763

    PubMed  Google Scholar 

  5. Hashemi J, Chandrashekar N, Gill B, Beynnon BD, Slauterbeck JR, Schutt RC, Mansouri H, Dabezies E (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Jt Surg Am 90:2724–2734

    Article  Google Scholar 

  6. Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT (2019) Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:1368–1377

    Article  Google Scholar 

  7. Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB (2019) Phenotyping of hip-knee-ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 27:1378–1384

    Article  Google Scholar 

  8. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27:1394–1402

    Article  Google Scholar 

  9. Innocenti B, Pianigiani S, Ramundo G, Thienpont E (2016) Biomechanical effects of different varus and valgus alignments in medial unicompartmental knee arthroplasty. J Arthroplasty 31:2685–2691

    Article  Google Scholar 

  10. Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R (2017) Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Jt J 99:640–646

    Article  Google Scholar 

  11. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  Google Scholar 

  12. Nunley RM, Nam D, Johnson SR, Barnes CL (2014) Extreme variability in posterior slope of the proximal tibia: measurements on 2395 CT scans of patients undergoing UKA? J Arthroplasty 29:1677–1680

    Article  Google Scholar 

  13. Okamoto S, Mizu-uchi H, Okazaki K, Hamai S, Nakahara H, Iwamoto Y (2015) Effect of tibial posterior slope on knee kinematics, quadriceps force, and patellofemoral contact force after posterior-stabilized total knee arthroplasty. J Arthroplasty 30:1439–1443

    Article  Google Scholar 

  14. Parvizi J, Nunley RM, Berend KR, Lombardi AV, Ruh EL, Clohisy JC, Hamilton WG, Della Valle CJ, Barrack RL (2014) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472:133–137

    Article  Google Scholar 

  15. Thienpont E, Bellemans J, Victor J, Becker R (2013) Alignment in total knee arthroplasty, still more questions than answers. Knee Surg Sports Traumatol Arthrosc 21:2191–2193

    Article  Google Scholar 

  16. Thienpont E, Parvizi J (2016) A new classification for the varus knee. J Arthroplasty 31:2156–2160

    Article  Google Scholar 

  17. Walker PS, Garg A (1991) Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Relat Res 227–235

  18. Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 31–43

  19. Yoon J-R, Han S-B, Jee M-K, Shin Y-S (2017) Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty. Medicine (Baltimore) 96

Download references

Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany

    Malin Meier, Dino Janssen, Johannes Beckmann & Raymond Best

  2. MedArtes Orthopaedic Surgery, Neutraubling, Germany

    Franz Xaver Koeck

  3. Cliniques Universitaires Saint-Luc, Bruxelles, Belgium

    Emmanuel Thienpont

Authors
  1. Malin Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dino Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Franz Xaver Koeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanuel Thienpont
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Johannes Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raymond Best
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes Beckmann.

Ethics declarations

Conflict of interest

FK receives royalties of Königsee and honoraria of ConforMIS, all outside the submitted work. DJ has received compensations covering the living costs in Boston from ConforMIS. JB receives honoraria from DePuy, Smith&Nephew and ConforMIS, all outside the submitted work. ET is a speaker bureau for ComaTec, KCI, Limo, Medacta, and Zimmer Biomet, receives royalties of Zimmer Biomet and is EKS President 2019, all outside the submitted work. RB has no potential conflict of interest. MM has no potential conflict of interest.

Ethical approval

Since the present study is based on analysing anonymised CT data, IRB approval was not required. Any information that could identify patients was not use in the analysis. Investigators dealt with anonymised data only. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meier, M., Janssen, D., Koeck, F.X. et al. Variations in medial and lateral slope and medial proximal tibial angle. Knee Surg Sports Traumatol Arthrosc 29, 939–946 (2021). https://doi.org/10.1007/s00167-020-06052-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06052-y

Keywords

Search

Navigation