Evidence map›Paper›PMID 30203197›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019

The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA.

Mo Saffarini, Luca Nover, Reha Tandogan, Roland Becker, Lukas B Moser, Michael T Hirschmann, Pier F Indelli

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  20. [Accuracy of patellar tendon at the attachment as anatomic landmark for rotational alignment of tibial component].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mo SaffariniReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland. journals@resurg.eu.ORCID http://orcid.org/0000-0002-9656-987X
Luca NoverReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
Reha TandoganÇankaya Orthopedics, Ankara, Turkey.
Roland BeckerBundesanstalt für Materialforschung und-prüfung (BAM), Berlin, Germany.
Lukas B MoserKantonsspital Baselland, Bruderholz, Basel, Switzerland.
Michael T HirschmannKantonsspital Baselland, Bruderholz, Basel, Switzerland.
Pier F IndelliStanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThere is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA.

methodsMedline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated.

resultsThe selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border.

conclusionsBecause of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE: Level IV, systematic review of level III and IV studies.

Indexed as

Anatomic LandmarksArthroplasty, Replacement, KneeHumansKnee JointTibiaAccuracyAnatomic landmarksReference axesReliabilityRepeatabilityTibial rotationTotal knee arthroplasty

Identifiers

PMID30203197

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.