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. 2023 May 19;13(5):855.
doi: 10.3390/jpm13050855.

The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA

Sébastien Parratte  1   2 , Jeremy Daxhelet  3 , Jean-Noel Argenson  2 , Cécile Batailler  4   5
Affiliations

The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA

Sébastien Parratte et al. J Pers Med. .

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.

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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.

Figures

Figure 1
Figure 1
Extramedullary guide to check the tibial slope and the coronal axis for the tibial cut.
Figure 2
Figure 2
Insertion of the deep medial collateral ligament (MCL) on the medial proximal tibial plateau (yellow arrows), which delineates the tibial cut axis (blue line) (a). The osteophytes resection improves the visualization of this landmark (b).
Figure 3
Figure 3
The deep MCL landmark allows us to determine the coronal axis of the tibial cut (a), and not only the height of the tibial cut medially, as the medial osteophyte landmark (b).
Figure 4
Figure 4
After the visualization of the tibial landmark, the cutting guide is positioned directly on this landmark and then set to the bone.
Figure 5
Figure 5
The tibial resection allows to confirm if the cut axis is satisfying: the cut tightness should be similar anteriorly and posteriorly, and the cut should be at the limit of the capsular attaches.
Figure 6
Figure 6
With the definitive implants, the tibial implant should be positioned in the soft tissues’ envelope respecting the deep MCL (a) and restoring the joint line height, visualized with the meniscal scar level (b).
See this image and copyright information in PMC

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