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The distal tibiofibular syndesmosis is a reliable landmark for 3° varus tibial resection in total knee arthroplasty: a radiological evaluation on 1296 cases

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the reproducibility and the accuracy of distal tibiofibular syndesmosis (DTFS) as landmark to perform controlled varus tibial resections during total knee arthroplasty (TKA). The hypothesis was that DTFS can be used to perform an accurate 3° varus tibial cut.

Methods

A retrospective analysis on a consecutive series of standard weightbearing full-length anteroposterior views of the lower limbs radiographic images was conducted. For each radiograph, the hip–knee–ankle (HKA) angle, the angle between the tibial mechanical axis and the line connecting the centre of the tibial spines and the DTFS (tibiofibular angle, TFA) and the medial proximal tibial angle (MPTA) were calculated. Each measurement was carried out twice by three independent observers, and intra- and inter-observer measurement reliability were assessed using the intraclass correlation coefficient (ICC) analysis.

Results

A total of 1296 lower limbs were analysed from a series of 648 weightbearing full-length anteroposterior radiographs. The ICC were > 90% for all measurements. The mean TFA value was 2.94 ± 0.68 (range 2.38–3.51). No differences were detected comparing the mean TFA value on the right and left limb (p = 0.795) as well as comparing the values in male and female patients (p = 0.691). Linear regression analysis did not find statistically significant correlation between TFA and MPTA, or TFA and HKA angles, respectively.

Conclusion

The distal tibiofibular syndesmosis is a reliable and easy reproducible radiographic landmark that can be used when planning a 3° varus tibial cut. Future studies are needed to confirm the validity of this method also in clinical settings.

Level of evidence

IV, retrospective case series.

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Availability of data and materials

All radiographic images used for this study are available in the database of the promoter center. This database can be consulted only by licensed physicians.

Code availability

Not applicable.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Institut Català de Traumatologia i Medicina de l’Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain

    Simone Perelli, Raul Torres-Claramunt & Juan Carlos Monllau

  2. Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain

    Simone Perelli, Pedro Hinarejos, Raul Torres-Claramunt, Juan Sanchez-Soler & Juan Carlos Monllau

  3. Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy

    Giuseppe Gianluca Costa & Arcangelo Russo

  4. Knee Unit, Department of Orthopedic Surgery and Traumatology, School of Medicine and University Hospital “Dr. José Eleuterio González”, Universidad Autonoma de Nuevo León, Monterrey, Mexico

    Rodolfo Morales-Avalos

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  1. Simone Perelli
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Contributions

SP was involved in concept and study design, data collection and statistical analysis; GGC was involved in manuscript writing and figures preparation, AR was involved in manuscript writing, PH, RT-C, JS-S were involved in data collection, RM-A was involved in study design and statistical analysis, JCM was involved in final revision and language editing.

Corresponding author

Correspondence to Giuseppe Gianluca Costa.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Barcelona (TIB-FIB-01).

Consent to participate

Informed consent was not obtained from participants included in the study, because all radiographic examinations were obtained for medical reasons not related to this study.

Consent to publish

All participants provided consent for anonymous publication of the radiographic images.

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Perelli, S., Costa, G.G., Russo, A. et al. The distal tibiofibular syndesmosis is a reliable landmark for 3° varus tibial resection in total knee arthroplasty: a radiological evaluation on 1296 cases. Arch Orthop Trauma Surg 144, 879–885 (2024). https://doi.org/10.1007/s00402-023-05099-z

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