|Year : 2015 | Volume
| Issue : 2 | Page : 166-169
A morphometric study of the proximal end of the tibia in South Indian population with its clinical implications
Chandni Gupta, Jitendra Kumar, Sneha Guruprasad Kalthur, Antony Sylvan D'souza
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||6-May-2015|
Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
Objective: Total knee arthroplasty and unicompartmental knee arthroplasty (UKA) are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures requires adequate sizing specific to the population. Hence, the aim of the present study is to measure various parameters of the proximal end of the tibia in south Indian population. Materials and Methods: Fifty (26 left and 24 right) adult fully ossified dry tibia were taken, and various parameters of the proximal end of the tibia were measured using a Vernier caliper. Statistical analysis of the parameters was done. Comparison between various parameters of right and left side was done using paired t-test. Results: In our study, the mean transverse, the anteroposterior diameter of total, medial and lateral condyles of the tibia are 6.83, 4.57, 2.73, 4.45 and 2.79, 4.07 cm. The area of medial, lateral and total tibial condyle is 12.2, 11.42 and 31.39 cm 2 . The mean length between the upper end of the tibia and tibial tuberosity and the mean circumference of the upper end of the tibia is 5.15 and 19.02 cm. Groove for ligamentum patellae was found in 100% of cases. Conclusion: The results of this study will be helpful for anatomists, anthropologists, and orthopedics in cases of UKA, complete knee arthroplasty procedures, and meniscal transplantation.
دنهلا يقرش ناكس يف ةيريرسلا اهراثآ و ةبيرقلا قاسلا ةياهن تاباصلإ ةيلكش ةسارد
بلطتت ةليدبلا ةبكرلاو ةبكرلا لصافم تاباهتلاو تاباصإ جلاع تاءارجإ ميوقت نا :ةساردلا فادها ةياهنلل ةفلتخملا ملاعملا سايق وه ةساردلا هذه نم فدهلا نإف يلاتلاب و .ناكسلل ايفاك ايعون اديدحت.دنهلا يبونج ناكس يف قاسلل ةبيرقلاا
تاياهن يف لاماك ارجحت نوناعي نيذلا نيغلابلا نم نيسمخ رايتخا مت : اهحهانم و ةساردلا تانيع راجرفلا مادختساب ةبيرقلا قاسلا تاياهنل ةفلتخملا ملاعملا سايق متو )نيمي 42 /راسي 26( قاّسلا نميلأاو رسيلأا نيبناجلا نم ةفلتخم ريياعم نيب ةنراقملاو ملاعملل يئاصحلأا ليلحتلا مت دقو ,ةينرولا )Paired Student test ( جودزملا رابنخلاا مادختساب
،4.57 ،6.83:يه قاسلا نم ةيبناجلا مقللا نم يفلخلاو يماملأا رطقلا نأ جئاتنلا ترهظأ :جئاتنلا مس 31.39و 11.42 ،12.2 قاسلا ماظع عومجم تناك ىطسولا ةقطنملا يفو مس 4,45 ،73و2 نم ةيولعلا ةياهنلا طيحمو ةبدحلا قاّسلا ماظعو قاسلا نم ةيولغلا ةياهتلا نيب لوطلا طسوتمو .عبرم ةبسنب تلااحلا عيمج يف ةفضرلا طابرل دودخلأا ىلع روثعلا مت دقو . مس19.02و 5.15 تناك قاسلا%100
ةحارجو ايجولوبورثنلأاو حيرشتلا تلااجم يف نيلماعلل ةديفم نوكتس ةساردلا هذه جئاتن :ةصلاخلا.يللاهلا فورضغلا عرز تلااحو , ةبكرلا تاباصإو لصافملا تاباهتلا تلااح يف ماظعلا
Keywords: Area, arthroplasty, condyles, knee, tibia
|How to cite this article:|
Gupta C, Kumar J, Kalthur SG, D'souza AS. A morphometric study of the proximal end of the tibia in South Indian population with its clinical implications. Saudi J Sports Med 2015;15:166-9
|How to cite this URL:|
Gupta C, Kumar J, Kalthur SG, D'souza AS. A morphometric study of the proximal end of the tibia in South Indian population with its clinical implications. Saudi J Sports Med [serial online] 2015 [cited 2023 Dec 4];15:166-9. Available from: https://www.sjosm.org/text.asp?2015/15/2/166/156354
| Introduction|| |
The knee joint is a compound synovial joint which brings out the significant function of adjusting the center of body mass and posture, requiring a great range of movement in three dimensions together with the capability to bear high forces.  The proximal end of tibia is a crucial component of the knee joint through the tibio-femoral articulation and plays a vital role in the conduction of body weight from the femur above to the talus below and is therefore unique in day-to-day functioning as well as in many sports. The knee joint is usually affected by several forms of arthritis such as inflammatory and posttraumatic arthritis due to regular playing of many sports like football and also osteoarthritis is the most common pathological disorder and the treatment for that is usually total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). 
Total knee arthroplasty is extensively recognized to be one of the most popular and cost effective procedures in orthopedic practice. Substantial development in quality of life after TKA procedures have been showed by several studies. Additional improvements have been attained by current technological progressions in prosthetic design, instrumentation, surgical techniques, and rehabilitation. 
Total knee arthroplasty is a precision operation, requiring precise soft-tissue balancing and resection of bone thickness equal to the thickness of the prosthetic component implanted, so that the flexion-extension spacing are equal, permitting joint stability throughout the range of motion. Prosthetic selection, accurate sizing and proper placement of the components decide the success of this procedure. The anteroposterior (AP) measurement of the prosthesis is significant in sustaining flexion-extension spacing while the mediolateral measurement decides satisfactory coverage of the resected bone surface and tension free wound closure.  Maximal implant coverage on the resected bone surface would decrease the stress applied to the bone implant interface, which has been found to be a reason contributing to long term survivorship in TKA. 
Unicompartmental knee arthroplasty is presently developing as a satisfactory possibility for the treatment of unicompartmental arthritis of the knee in elderly patients.  The prostheses, which are presently being used in the practice are best suited for the western population therefore leading to implant size incompatibility with the resected bony surfaces. 
Hence, the aim of this study is to measure the dimensions of the proximal tibia, which can serve as guidelines for designing a suitable tibial component of total knee prostheses for Indian population.
| Materials and methods|| |
The study was carried out on 50 dry tibia (24 right and 26 left). All bones were adult type and without any signs of erosion. Following parameters were studied on the proximal end of tibia [Figure 1] and [Figure 2]:
|Figure 1: Measurements done on tibia. (a) Transverse diameter of tibial condyle. (b) Anteroposterior diameter of intercondylar region. (c) Length between upper end and tibial tuberosity. (d) Circumference of upper end|
Click here to view
|Figure 2: Measurements done on tibia. (a) Transverse diameter of medial tibial condyle. (b) Anteroposterior diameter of medial tibial condyle. (c) Transverse diameter of lateral tibial condyle. (d) Anteroposterior diameter of lateral tibial condyle|
Click here to view
All measurements were taken with the help of vernier caliper. Area of the condyle was measured using the formula:
- AP diameter of medial tibial condyle
- Transeverse diameter (TD) of medial tibial condyle
- AP diameter of lateral tibial condyle
- TD lateral tibial condyle
- TD of total tibial condyle
- AP diameter of intercondylar region
- Circumference of the upper end
- Length between the upper end and tibial tuberosity
- Area of total tibial condyle
- Area of medial tibial condyle
- Area of lateral tibial condyle
- Presence or absence of groove for ligamentum patellae.
Area of condyle = AP × TD of condyle
All the areas have been statistically analyzed and mean has been calculated for areas of medial condyle, lateral condyle, and total tibial condyle. The percentage has been calculated of medial and lateral condyle area out of total tibial condylar area.
Statistical analysis was done for all the parameters. Paired sample t-test was done to see the statistical significance between right and left side.
| Results|| |
The mean and range of all the parameters of the right, left and total tibia is shown in [Table 1].
|Table 1: Mean and range of all parameters of right, left and total tibia|
Click here to view
Groove for ligamentum patellae on the tibial tuberosity was present in 100% of cases.
There was statistically significant relation between right and left AP diameter of medial condyle, transverse diameter of lateral condyle and area of the lateral condyle as P value was 0.045, 0.001 and 0.046. However, there was no significant relation with other parameters of right and left side as P > 0.05.
In our study, the area covered by medial tibial condyle is 38.87% and by lateral tibial condyle is 34.4% out of total condylar area in the right side. The area covered by medial tibial condyle is 38.89% and by lateral tibial condyle is 38.25% out of total conylar area in the left side.
| Discussion|| |
The geometry and anatomy of the knee is variable, irrespective of gender and the human race and it should be considered carefully during the design process of the tibia prosthesis for the TKA. 
Yan et al.  found the AP and transverse diameter on the proximal tibia section as 4.9 ± 0.39 cm and 7.3 ± 0.56 cm respectively. In our studies, we also got almost the similar values as 4.57 ± 0.39 cm and 6.83 ± 0.51 cm. 
Ivan found the mean transverse length on the left, right and total tibia as 6.66 ± 0.56, 6.62 ± 0.51 and 6.64 ± 0.53 cm our values were almost similar to their study and the values in our study are 6.88 ± 0.65, 6.77 ± 0.31 and 6.83 ± 0.51 cm. She found the mean AP length of medial condyle on the left, right and total tibia as 4.13 ± 0.42, 4.08 ± 0.42 and 4.10 ± 0.42 cm and the values are almost similar in our study as 4.36 ± 0.47, 4.55 ± 0.29 and 4.45 ± 0.40 cm. The mean AP length of the lateral condyle on the left, the right and total tibia in her study was 3.54 ± 0.39, 3.67 ± 0.41 and 3.61 ± 0.40 cm. In our study, the values are 4.06 ± 0.40, 4.08 ± 0.27 and 4.07 ± 0.34 cm. The mean intercondylar AP length on the left, right and total tibia was 4.49 ± 0.44, 4.25 ± 0.42 and 4.20 ± 0.43 cm in her study and we got the values as 4.49 ± 0.44, 4.66 ± 0.32 and 4.57 ± 0.39 cm. 
Ivan also found the mean circumference of the upper end of tibia on the left, right and total tibia as 19.36 ± 1.5, 19.33 ± 1.44 and 19.35 cm, which was almost similar to our study as 19.07 ± 1.65, 18.95 ± 0.68 and 19.02 ± 1.27 cm. The mean length from the upper end of tibia to the tibial tuberosity in her study on the left, right and total tibia was 4.47 ± 0.61, 4.60 ± 0.68 and 4.54 cm while in our study the values are 5.24 ± 0.71, 5.06 ± 0.59 and 5.15 ± 0.65 cm. She found the groove for ligamentum patellae was present in 73.9% of the total number of bones while in our study, we got that in 100% of bones. She found no statistical significance in any parameters of tibia on right and left side but in our study we got statistical significance relation between right and left AP diameter of medial condyle, transverse diameter of lateral condyle and area of lateral condyle as P value was 0.045, 0.001 and 0.046. 
Bae and Park found average transverse length of the proximal tibia as 7.27 ± 0.40 cm while in our study the value is 6.83 ± 0.51 cm. They found the average AP length of medial and lateral plateau as 4.80 ± 0.31 and 3.98 ± 0.29 cm which was similar to our study as 4.45 ± 0.40 and 4.07 ± 0.34 cm. 
Kwak et al. found the mean transverse and AP diameter of proximal end of tibia as 7.35 ± 0.56 and 4.73 ± 0.38 cm while in our study the values are 6.83 ± 0.51 and 4.57 ± 0.39 cm. 
Srivastava et al. found the mean transverse, AP diameter of medial and lateral condyle on right side as 2.97, 3.86 cm and 2.92, 3.64 cm. They found the mean transverse, AP diameter of medial and lateral condyle on the left side as 2.75, 3.99 cm and 2.97, 3.69 cm. While in our study, we got the values as 2.7, 4.55 cm and 2.66, 4.08 on the right side and 2.76, 4.36 cm and 2.92, 4.06 cm on the left side. They found the total tibial condylar, medial condyle, lateral condyle area on right and left side as 29.88, 11.52, 10.75 and 29.51, 11.01, 10.52 cm 2 these values were almost similar to our study and we got the values as 31.64, 12.30, 10.89 and 31.16, 12.12, 11.92 cm 2 . 
Srivastava et al. found that the area covered by medial tibial condyle is 38.56% and by lateral tibial condyle is 35.97% out of total condylar area in right side. The area covered by medial tibial condyle is 37.32% and by lateral tibial condyle is 35.65% out of total conylar area in the left side which was similar to our study as the values in our study are 38.87% and 34.4% for medial and lateral tibial condyle in right side and 38.89% and 38.25% on left side. 
Total knee arthroplasty and UKA are both meticulous surgeries which necessitate the precision in the prosthesis sizing to ensure an effective result as well as long term survival of the same. Suitable prosthetic design is crucial to restore the normal function in patients postoperatively.  Inadequate tibial coverage can lead to tibial implant collapse because of the load being shifted to cancellous bone instead of cortical bone. 
As most of the conventional prostheses available in the market are designed for Caucasians, Indians having smaller anatomical profiles would need smaller sized components of knee prosthesis. Hence, the results of this study would be of significant value in the manufacture of the tibial component of knee prostheses in the Indian population for both UKA as well as TKA. By using these guidelines, prostheses which are best suited for this population can be manufactured and this would ensure optimal tibial implant coverage, which has been found to be a crucial factor in long-term survivorship of the prosthesis.
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Ivan AS. Morphometric Study of Proximal End of Tibia; 2014. p. 75. Available from: http://www.rguhs.ac.in/cdc/onlinecdc/uploads/01_M010_25888.doc.
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[Figure 1], [Figure 2]
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