Is the Akagi Line a Reliable Landmark for Adjusting the Rotational Axis of the Tibial Component in Patients with Patellofemoral Instability?,Indian Journal of Orthopaedics

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Is the Akagi Line a Reliable Landmark for Adjusting the Rotational Axis of the Tibial Component in Patients with Patellofemoral Instability?
Indian Journal of Orthopaedics ( IF 1.1 ) Pub Date : 2023-03-30 , DOI: 10.1007/s43465-023-00868-9
Mehmet Barıs Ertan ₁ , Ozkan Kose ₁ , Ersin Tasatan ₂ , Albert Cakar ₃ , Mehmet Melih Asoglu ₁ , İsmail Dikmen ₁

Affiliation

Purpose

This study aimed to investigate whether the Akagi line is a reliable anatomic landmark for adjusting the rotational axis of the tibial component in patients with patellofemoral (PF) malalignment.

Materials and methods

This retrospective case–control study included 86 patients with PF instability and 129 controls. On the superimposed axial CT images, TT-TG, TT-PCL, nTT-TG, nTT-PCL, knee joint rotation, and the angle between the Akagi line and surgical transepicondylar axis (Akagi/sTEA angle) were measured. In addition, a modified Akagi line, drawn 1 cm medial to the patellar tendon attachment, was defined, and the angle between the new Akagi line and sTEA (mAkagi/sTEA angle) was also measured and compared between groups.

Results

There were 86 patients (47 females, 39 males) in the case group and 129 patients (56 females, 73 males) in the control group with a mean age of 35.7 ± 17.9 years and 41.1 ± 18.8 years, respectively (p < 0.001). Radiologic variables of PF alignment (TT-TG, TT-PCL, nTT-TG, nTT-PCL, and knee joint rotation) were significantly abnormal in the case group (p < 0.001 for all variables). The Akagi/sTEA angle was significantly higher in the case group, resulting in 89.5% external malrotation of the tibial component (> 10°). However, the tibial component was 96.5% aligned correctly (between 10° external and 3° internal rotation) in the control group. Using the modified Akagi line significantly improved the rotational alignment, and normal tibial rotation increased to 93.3% of the case group. The Akagi/sTEA angle strongly correlated with the knee rotation (rho: 0.735, p: 0.001), TT-TG (rho: 0.715, p: 0.001) and nTT-TG (rho: 0.783, p: 0.001). But the TT-PCL (rho: 0.459, p: 0.001) and nTT-PCL (rho: 0.589, p: 0.001) had a medium correlation.

Conclusions

The Akagi line might cause unacceptable external rotation of the tibial component in patients with PF malalignment. The use of the modified Akagi line described in this study may be a solution for the rotational mismatch between femoral and tibial components in TKA.

Level of evidence

Level III, retrospective case–control study.

中文翻译：

赤城线是调整髌股不稳患者胫骨假体旋转轴的可靠标志吗？

目的

本研究旨在探讨赤城线是否是调整髌股（PF）排列不正患者胫骨假体旋转轴的可靠解剖标志。

材料和方法

这项回顾性病例对照研究包括 86 名 PF 不稳定的患者和 129 名对照者。在叠加的轴向 CT 图像上，测量 TT-TG、TT-PCL、nTT-TG、nTT-PCL、膝关节旋转以及 Akagi 线和手术经上髁轴之间的角度（Akagi/sTEA 角）。此外，定义了一条修改后的赤城线，在髌腱附着点内侧1厘米处绘制，并且还测量了新赤城线和sTEA之间的角度（mAkagi/sTEA角度）并在组间进行比较。

结果

病例组有 86 名患者（47 名女性，39 名男性），对照组有 129 名患者（56 名女性，73 名男性），平均年龄分别为 35.7 ± 17.9 岁和 41.1 ± 18.8 岁（ p < 0.001）。 PF 排列的放射学变量（TT-TG、TT-PCL、nTT-TG、nTT-PCL 和膝关节旋转）在病例组中显着异常（所有变量p < 0.001）。病例组的 Akagi/sTEA 角明显较高，导致 89.5% 的胫骨假体外旋不良（> 10°）。然而，对照组的胫骨假体的正确对准率为 96.5%（外旋 10° 内旋 3°）。使用改良的 Akagi 线显着改善了旋转对准，正常胫骨旋转增加至病例组的 93.3%。 Akagi/sTEA 角度与膝关节旋转（rho：0.735， p ：0.001）、TT-TG（rho：0.715， p ：0.001）和 nTT-TG（rho：0.783， p ：0.001）密切相关。但 TT-PCL（rho：0.459， p ：0.001）和 nTT-PCL（rho：0.589， p ：0.001）具有中等相关性。