SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018
Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
59 citing papers in PubMed, 5 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Tibia rotational alignment in total knee arthroplasty: Delphi consensus statements from European Knee Society (EKS).Archives of orthopaedic and trauma surgery · 2025Pooled it
- Computer-assisted surgery and patient-specific instrumentation improve the accuracy of tibial baseplate rotation in total knee arthroplasty compared to conventional instrumentation: a systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Midflexion instability in total knee arthroplasty: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Pooled it
- Femoral component malrotation is not correlated with poor clinical outcomes after total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Pooled it
- MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review.Journal of magnetic resonance imaging : JMRI · 2020Pooled it
- Measured resection, gap balancing, and force-sensor-guided total knee arthroplasty result in different femoral and tibial rotational alignment but similar combined knee rotation and clinical outcomes: a randomized controlled trial.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2026Trial
- Accuracy of different navigation systems for femoral and tibial implantation in total knee arthroplasty: a randomised comparative study.Archives of orthopaedic and trauma surgery · 2021Trial
- Association between abnormal native tibial torsion and poorer clinical outcomes following robotic-assisted total knee arthroplasty: follow-up of at least two years.Journal of robotic surgery · 2026Article
- Limited ability of coronal alignment parameters to assess rotational alignment in patients with varus knee osteoarthritis: a cross-sectional study.BMC musculoskeletal disorders · 2026Article
- Patient-reported outcomes and component rotation in total knee replacement: a prospective, observational study in 498 patients.BMJ open · 2026Observational
- Article
- Current Uses for Medical Imaging With Orthopaedic Implant Technology.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2026Review
- Three-dimensional verification of osteotomy accuracy in total knee arthroplasty using intraoperative CT imaging: a case series study.BMC musculoskeletal disorders · 2025Article
- The augmented reality-aided navigation system may improve rotational alignment of the tibial baseplate in total knee arthroplasty.BMC musculoskeletal disorders · 2025Article
- Comprehensive Impact of Multiplanar Malalignment on Prosthetic Mechanics Under Gait Loading After Total Knee Arthroplasty-A Finite Element Analysis.Orthopaedic surgery · 2025Article
- Effect of tibial rotational alignment and posterior slope on joint biomechanics in posterior-stabilized total knee arthroplasty: a finite element study.European journal of medical research · 2025Article
- Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty.BMC musculoskeletal disorders · 2025Article
- Curve-on-curve technique is more reliable than free-floating technique for tibial components positioning in posterior stabilized total knee arthroplasty using symmetrical tibial components in varus osteoarthritis.BMC musculoskeletal disorders · 2024Article
- Anteroposterior axis of the tibia for kinematic aligned total knee arthroplasty.Journal of experimental orthopaedics · 2024Article
- Variability of three-dimensional knee morphology cannot be effectively assessed using a coronal plane knee alignment classification in total knee arthroplasty patients.Journal of experimental orthopaedics · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes.
methodsA detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms "total knee arthroplasty", "total knee replacement", "tibial alignment", "tibial malalignement", "tibial rotation", "rotational error", "axis", "angle", "tibial malrotation", "clinical outcome", in several combinations. The modified Coleman scoring methodology (mCMS) was used. All the primary TKAs studies analyzing correlation between clinical results and tibial rotation were included.
resultsFive articles met the inclusion criteria. A total of 333 arthroplasties were included in this review; 139 had tibial component malalignment, while 194 were in control groups. The mean age of patients was 67.3 (SD 0.57) years. The mean average postoperative follow-up delay was 34.7 months (range 21-70). The mean mCMS score was 59.2 points indicating good methodological quality in the included studies. Functional outcomes were assessed through KSS, OKS, KOOS and VAS, negatively related to tibial internal rotation.
conclusionsOur review confirmed that excessive internal rotation of the tibial TKA component represents a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation does not affect the results. However, a universal precise cut-off value has not been found in the available literature and there remains a debate about CT rotation assessment and surgical intra-operative landmarks. LEVEL OF EVIDENCE: III.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.