The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA
- PMID: 37241025
- PMCID: PMC10222460
- DOI: 10.3390/jpm13050855
The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA
Abstract
The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help the surgeon to improve accuracy. The technique described in this paper is based on the use of a simple and reproducible anatomical landmark. This landmark is the line of insertion of the fibers of the deep medial collateral ligament (MCL) around the anterior half of the medial tibial plateau called the "Deep MCL insertion line". The used anatomical landmark determines the orientation (in the coronal and sagittal planes) and the thickness of the tibial cut. This landmark corresponds to the line of insertion of the fibers of the deep MCL around the anterior half of the medial tibial plateau. A consecutive series of patients who underwent primary medial UKA between 2019 and 2021 were retrospectively reviewed. A total of 50 UKA were included. The mean age at the time of surgery was 54.5 ± 6.6 years (44-79). The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements. The limb and implant alignments and the tibial positioning were satisfying, with a low rate of outliers and good restoration of the native anatomy. The landmark of the insertion of deep MCL constitutes a reliable and reproducible reference for the tibial cut axis and thickness during medial UKA, independent of the wear severity.
Keywords: anatomical landmarks; coronal alignment; deep medial collateral ligament; medial unicompartmental knee arthroplasty; tibial slope.
Conflict of interest statement
The authors declare no conflict of interest related to this work. S.P.: Royalties from Zimmer Biomet and Newclip; Consultant for Zimmer Biomet; Treasurer for European Knee Society. J.D. and C.B.: No conflict of interest. J.-N.A.: Educational Consultant and royalties from Zimmer-Biomet.
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References
-
- Barbadoro P., Ensini A., Leardini A., d’Amato M., Feliciangeli A., Timoncini A., Amadei F., Belvedere C., Giannini S. Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: A radiographic and radiostereometric study. Knee Surg. Sport. Traumatol. Arthrosc. 2014;22:3157–3162. doi: 10.1007/s00167-014-3147-6. - DOI - PubMed
-
- Epinette J.A., Brunschweiler B., Mertl P., Mole D., Cazenave A., The French Society for the Hip and Knee Unicompartmental knee arthroplasty modes of failure: Wear is not the main reason for failure: A multicentre study of 418 failed knees. Orthop. Traumatol. Surg. Res. 2012;98:S124–S130. doi: 10.1016/j.otsr.2012.07.002. - DOI - PubMed
-
- Bell S.W., Anthony I., Jones B., MacLean A., Rowe P., Blyth M. Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study. J. Bone Jt. Surg. Am. Vol. 2016;98:627–635. doi: 10.2106/JBJS.15.00664. - DOI - PubMed
-
- Ponzio D.Y., Lonner J.H. Robotic Technology Produces More Conservative Tibial Resection Than Conventional Techniques in UKA. Am. J. Orthop. 2016;45:E465–E468. - PubMed
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