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Bedeutung des tibialen Slopes in der Knieendoprothetik

Importance of the tibial slope in knee arthroplasty

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Zusammenfassung

Das funktionelle Zusammenspiel von knöchernen und ligamentären Strukturen ist für die postoperative Biomechanik und Standzeit von Kniegelenkendoprothesen von herausragender Bedeutung. Trotz aller technischen Fortschritte und wissenschaftlichen Bemühungen ist aktuell unzureichend geklärt, welche Bedeutung der komplexen Anatomie des Tibiaplateaus und insbesondere ihrer dorsalen Inklination (tibialer Slope) in der Knieendoprothetik zugeschrieben werden soll. Vor diesem Hintergrund erfolgte die Auswertung, kritische Auseinandersetzung und Darstellung der gegenwärtigen wissenschaftlichen Datenlage. Der tibiale Slope nimmt Einfluss auf den postoperativen Bewegungsumfang, die Funktion des Streckapparat sowie Abrieb, Lockerung und Instabilität der Kniegelenkendoprothese. Die Literaturlage ist jedoch äußerst heterogen und Empfehlungen für einen optimalen tibialen Slope reichen von 0° bis 10°. Allerdings gibt es in den letzten Jahren zunehmend Bestrebungen, den präoperativen tibialen Slope zu rekonstruieren. Allen Studien ist gemein, dass bereits eine präoperative Auseinandersetzung mit dem tibialen Slope empfohlen wird.

Abstract

Notwithstanding the contributions of soft tissue restraints on postoperative kinematics and long-term survival after total knee arthroplasty (TKA), there is an emerging consensus that the underlying anatomy, especially the posterior inclination of the tibial plateau in the sagittal plane (tibial slope), might just have a comparable impact. However, this has not been fully elucidated as yet. Therefore, a thorough literature search, analysis and presentation of current scientific data was conducted. The tibial slope has been shown to relate linearly to the postoperative range of motion and function of the extensor mechanism. Furthermore, it impacts wear of the tibial insert and loosening, as well as instability of the TKA. As no consensus has been reached on the ideal tibial slope, recommendations range from 0° to 10°. Notably, more recent studies favor reconstructing the native, preoperative tibial slope, and the majority of authors advocate that knowledge of this is crucial for optimal TKA surgery.

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Abbreviations

ATC:

„Anterior tibial cortex“

CR:

„Cruciate retaining“

HKB:

Hinteres Kreuzband

PE:

Polyethylen

PS:

„Posterior stabilized“

PTC:

„Posterior tibial cortex“

TLA:

„Tibial long axis“

VKB:

Vorderes Kreuzband

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Silvan Wittenberg MD, Ufuk Sentuerk MD, Lisa Renner MD, Claude Weynandt MD, Carsten F. Perka MD, Ph.D & Clemens Gwinner MD

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  1. Silvan Wittenberg MD
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  2. Ufuk Sentuerk MD
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Correspondence to Silvan Wittenberg MD.

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Interessenkonflikt

S. Wittenberg, U. Sentuerk, L. Renner, C. Weynandt, C.F. Perka und C. Gwinner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wittenberg, S., Sentuerk, U., Renner, L. et al. Bedeutung des tibialen Slopes in der Knieendoprothetik. Orthopäde 49, 10–17 (2020). https://doi.org/10.1007/s00132-019-03777-8

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