Mid-sulcus line predictive guide for tibial mechanical axis during TKA

Alok Umre et al found in a study that-"Mid-sulcus line can be used as an additional anatomical landmark to guide the tibial resection and thereby achieve appropriate coronal alignment in primary TKAs without any extra-articular deformity."

Achieving appropriate alignment of components in total knee arthroplasty (TKA) is essential for optimal functional outcomes as well as implant longevity. Performing TKA in the absence of a computer-assisted navigation system (CANS) mandates the use of accurate anatomical landmarks for achieving appropriate alignment. In this study, authors have evaluated the reliability of ‘mid-sulcus line’ as an anatomical landmark to guide tibial resection, with the intra-operative help of CANS.

The study was conducted at Department of Orthopaedics, Arogyam Superspeciality Hospital, Nagpur, India. The article has been published in ‘The Knee’ journal. A total of 322 patients undergoing primary TKA (excluding previously operated limbs and limbs with extra-articular deformities of tibia or femur) using CANS were included in the study. After resecting ACL, the mid-sulcus line was drawn with a cautery tip. The authors hypothesized that if tibial cut was made perpendicular to the mid-sulcus line, coronal alignment of the tibial component would be along the neutral mechanical axis. This was evaluated intra-operatively with the help of CANS.