Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 9, pp 1287–1292 | Cite as

The epicondylar ratio can be reliably used on X-ray of the knee to determine the joint line

  • Bernd Lutz
  • Angela Trubrich
  • Thomas Kappe
  • Heiko Reichel
  • Ralf Bieger
Knee Revision Surgery

Abstract

Purpose

The epicondylar ratio (ER) is used to restore the individual joint line (JL), especially in revision total knee arthroplasty. It was first described in magnetic resonance imaging (MRI) but is usually applied to a.p. radiographs of the knee for preoperative planning. The objective of the current study was to define reliable landmarks in MRI and X-ray images of the knee, which allow comparison of the image modalities. Furthermore, the correlation of the measured ER in MRI and X-rays of the knee was calculated.

Methods

A consecutive series of 87 patients who underwent an arthroscopical intervention of the knee were included into the present study. The lateral epicondyle was defined as the most lateral and distal prominence. On the medial side, the measurement was aligned to the epicondylar sulcus. The medial and lateral ER were calculated by dividing the perpendicular distance from the JL to the epicondyle by the transepicondylar distance. One observer determined the ER twice to calculate the intramethod intraobserver agreement, and a second observer obtained the intramethod interobserer agreement. The ER obtained from X-ray and MRI was compared to calculate the intermethod correlation.

Results

The average lateral ER was 0.29 on X-ray versus 0.28 on MRI. The average medial ER was 0.33 and 0.33, respectively. Intramethod agreement ranged from 0.66 to 0.88 and intermethod correlation from 0.49 to 0.57.

Conclusions

The ER can be determined reliably on MRI and X-ray images of the knee. The correlation of the ER in MRI and X-ray is fair.

Keywords

Knee arthroplasty Joint line Epicondylar ratio Revision arthroplasty 

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Anyway, the study was approved by the ethic committee of the university.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PFM (2011) Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Jt Surg Br Br Ed Soc Bone Jt Surg 93:1223–1231CrossRefGoogle Scholar
  2. 2.
    Bellemans J (2004) Restoring the joint line in revision TKA: does it matter? Knee 11:3–5CrossRefPubMedGoogle Scholar
  3. 3.
    Berend ME, Meding JB, Malinzak RA, Faris PM, Jackson MD, Davis KE, Ritter MA (2016) ACL damage and deficiency is associated with more severe preoperative deformity, lower range of motion at the time of TKA. HSS J Springer US 12:235–239Google Scholar
  4. 4.
    Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T (2014) The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 134:537–541CrossRefPubMedGoogle Scholar
  5. 5.
    Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290CrossRefGoogle Scholar
  6. 6.
    Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Jt Surg Am 68:1035–1040CrossRefGoogle Scholar
  7. 7.
    Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15:354–359CrossRefPubMedGoogle Scholar
  8. 8.
    Hofmann AA, Kurtin SM, Lyons S, Tanner AM, Bolognesi MP (2006) Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty. J Arthroplasty 21:1154–1162CrossRefPubMedGoogle Scholar
  9. 9.
    Iacono F, Presti Lo M, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci M (2013) The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc Springer Berlin Heidelberg 21:2725–2729CrossRefGoogle Scholar
  10. 10.
    Iacono F, Raspugli GF, Filardo G, Bruni D, Zaffagnini S, Bignozzi S, Presti Lo M, Akkawi I, Neri MP, Marcacci M (2015) The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:3212–3217CrossRefPubMedGoogle Scholar
  11. 11.
    Itokazu M, Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H (2016) Anatomical landmarks of the distal femoral condyles are not always parallel to the tibial bone cut surface in flexion during total knee arthroplasty. Knee Elsevier B.V. 23:1–5Google Scholar
  12. 12.
    Kim AD, Scott RD (2016) Can the visibility of both prosthetic posterior femoral condyles on a postoperative radiograph assure that limb rotation is appropriate to allow accurate measurement of the anatomic knee axis? J Arthroplasty Elsevier Ltd 31:2593–2596CrossRefGoogle Scholar
  13. 13.
    Kowalczewski JB, Labey L, Chevalier Y, Okon T, Innocenti B, Bellemans J (2015) Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis. AOMS Termedia 2:311–318CrossRefGoogle Scholar
  14. 14.
    König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28:1–5PubMedGoogle Scholar
  15. 15.
    Kuster MS, Bitschnau B, Votruba T (2004) Influence of collateral ligament laxity on patient satisfaction after total knee arthroplasty: a comparative bilateral study. Arch Orthop Trauma Surg Springer-Verlag 124:1–3CrossRefGoogle Scholar
  16. 16.
    LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89:2000–2010Google Scholar
  17. 17.
    Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331:102–106CrossRefGoogle Scholar
  18. 18.
    Lustig S, Lavoie F, Selmi TAS, Servien E, Neyret P (2008) Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study. Knee Surg Sports Traumatol Arthrosc 16:674–682CrossRefPubMedGoogle Scholar
  19. 19.
    Luyckx T, Beckers L, Colyn W, Vandenneucker H, Bellemans J (2014) The adductor ratio: a new tool for joint line reconstruction in revision TKA. Knee Surg Sports Traumatol Arthrosc 22:3028–3033CrossRefPubMedGoogle Scholar
  20. 20.
    Maderbacher G, Keshmiri A, Schaumburger J, Springorum H-R, Zeman F, Grifka J, Baier C (2014) Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study. Int Orthop 38:1173–1181CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mahoney OM, Kinsey TL (2006) Modular femoral offset stems facilitate joint line restoration in revision knee arthroplasty. Clin Orthop Relat Res 446:93–98CrossRefPubMedGoogle Scholar
  22. 22.
    Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156Google Scholar
  23. 23.
    Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171CrossRefGoogle Scholar
  24. 24.
    Pietrini SD, LaPrade RF, Griffith CJ, Wijdicks CA, Ziegler CG (2009) Radiographic identification of the primary posterolateral knee structures. Am J Sports Med 37:542–551CrossRefPubMedGoogle Scholar
  25. 25.
    Radtke K, Becher C, Noll Y, Ostermeier S (2009) Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg 130:451–457CrossRefPubMedGoogle Scholar
  26. 26.
    Rouvillain J-L, Pascal-Mousselard H, Favuto M, Kanor M, Garron E, Catonne Y (2008) The level of the joint line after cruciate-retaining total knee replacement: a new coordinate system. Knee 15:31–35CrossRefPubMedGoogle Scholar
  27. 27.
    Seil R, Pape D (2011) Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1418–1432CrossRefPubMedGoogle Scholar
  28. 28.
    Servien E, Viskontas D, Giuffrè BM, Coolican MRJ, Parker DA (2007) Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:263–269CrossRefPubMedGoogle Scholar
  29. 29.
    Wijdicks CA, Griffith CJ, LaPrade RF, Johansen S, Sunderland A, Arendt EA, Engebretsen L (2009) Radiographic identification of the primary medial knee structures. J Bone Jt Surg Am 91:521–529CrossRefGoogle Scholar
  30. 30.
    Wyss TF, Schuster AJ, Münger P, Pfluger D, Wehrli U (2006) Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line? Arch Orthop Trauma Surg 126:480–486CrossRefPubMedGoogle Scholar
  31. 31.
    Yoshii I, Whiteside LA, White SE, Milliano MT (1991) Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty 6:169–177CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of UlmUlmGermany

Personalised recommendations