Abstract
INTRODUCTION
Recent studies indicated that the knee has a single flexion/extension axis but debated the location of this axis. The relationship of the flexion/extension axis in the coronal plane to the mechanical axis has received little attention. The purpose of this study was to investigate the relationship of the various axes and references with respect to the mechanical axis in the coronal plane
MATERIALS AND METHODS
Subjects were prospectively scanned into a Virtual Bone Database (Stryker Orthopaedics, Mahwah, NJ). Database is a collection of body CT scans from subjects collected globally. Only CT Scans that met the following qualifications were accepted: ≤1 mm voxels and had slice thickness that was equal to the spacing between the slices (≤ 1.0mm).
For each CT Scan, a frontal plane was created through the 2 most posterior points of the medial/lateral condyles and the most posterior point of the trochanter. Then, a transverse plane was created perpendicular to the frontal plane and bisects the 2 most distal points on the medial/lateral condyles. Finally, a saggital plane was created that was perpendicular to the frontal and transversal planes.
The following axes were identified: Mechanical Axis of the Femur (MAF) (line between the center of the femoral head and the center of the knee sulcus); Transepicondylar Axis Posterior Cylindrical Axis (PCA) (line between the Medial/Lateral Condylar Circle – best fit circle to three points identified on surface).
Measurements made: Angle of MAF and the Joint-Line (Femoral Joint Angle), Angle of the MAF and the Transepicondylar Axis (Femoral TE Angle), and Angle of the MAF and the Posterior Cylindrical Axis (Femoral PC angle). Angles measuring 90° were neutral or perpendicular to the MAF. Angles measured <90° were valgus and >90° were varus.
RESULTS
CT Scans from 519 knees were studied. The mean femoral joint angle was 86.1°±2.0°(Range:80.2°-92.2°). The mean TE angle was 88.8°±2.5°(Range:81.7°-98.4°). The mean Femoral PC angle was 87.9°±2.2°(Range:81.8°-94.0°). The average deviations from a neutral resection were 3.8°, 1.2° and 2.1° for the Femoral Joint Angle, Femoral TE Angle respectively. The mean Femoral Joint angle had the lowest variability, while the mean Femoral TE angle showed the largest.
CONCLUSION
On average, the transepicondylar axis and the posterior cylindrical axis were approximately perpendicular to the mechanical axis in the coronal plane. Although surgeons do not align components in the coronal plane specifically to either axis, this data suggests that the average value is within the accepted ±3° range reported. The PCA values are closer to the values of the femoral joint line when compared to the TEA. The PCA may be a more reproducible landmark as it may be determined by either preoperative imaging or intraoperatively from instrumentation that references the distal/posterior surfaces. Further research is warranted.
