Anatomic rotational relationships of the proximal tibia, distal femur, and patella: Implications for rotational alignment in total knee arthroplasty

The orientation of the femur, tibia, and patella are important considerations in total knee arthroplasty. Our goal was to describe the relationships between the femoral epicondylar (FE) axis, posterior femoral (PF) axis, posterior tibial (PT) axis, patellar (PAT) axis, and patellar ligament (PL). A secondary goal was to determine where the short axis of the tibial tray intersects the patellar ligament as a function of tibial component rotation. Thirty normal magnetic resonance imaging (MRI) scans were analyzed. Strong relationships were found between the FE and PAT axes (2° ± 3°, r² = 0.73), and between the FE and PF axes (6° ± 2°, r² = 0.77). When the tibial baseplate was aligned along the PT axis, 30% of the cases were in an ideal position. When the FE axis was used, 73% were ideal.