Tibial Tubercle in Valgus Osteoarthritic Knees Is More Laterally Positioned Than in Varus Knees

The tibial tubercle (TT) is the most reliable landmark of the tibial component rotation in total knee arthroplasty. However, there is no report comparing the position of the TT between valgus and varus osteoarthritic knees.

Using preoperative computed tomography, we measured the TT-posterior cruciate ligament (PCL) distance representing the degree of lateralization of the TT and the angle between Akagi’s anteroposterior (AP) axis and the dorsal condylar line (DCL) of the tibia in 36 valgus and 40 varus osteoarthritic knees and compared them.

The mean TT-PCL distances in valgus and varus knees were 26.1 (18.2-36.8) and 17.2 mm (10.3-22.6), respectively, with a significant difference (P < .001). Twenty-four of 36 valgus knees (67%) had abnormal TT-PCL (>24 mm). The mean AP-DCL angles in valgus and varus knees were 103° (95.8°-114.8°) and 93.2° (85.3°-99.6°), respectively, with a significant difference (P < .001).

The TT in valgus knees was significantly more laterally positioned than in varus knees. Also, Akagi’s AP axis in valgus knees was significantly more externally rotated relative to the DCL of the tibia than in varus knees. Attention is necessary to correct rotational alignment without posterolateral overhang of the tibial component during total knee arthroplasty, particularly for valgus knees.