Assessing Tibial Tray Rotation in TKA: A Cadaveric Study

Tibial anatomical landmarks for transverse plane rotation of the tibial tray have not been validated. The current authors propose aligning the tibial tray with both the anterior tibial center point of rotation (ATCPR) and the femoral trochlear groove (FTG) to establish the ideal tibial tray rotation in total knee arthroplasty (TKA). When the tibial tray centerline was aligned with ATCPR and FTG lines, the mean range of motion (ROM) was 144.3° (preoperatively 145°) and tibial rotation range was 22.8 mm (preoperatively, 24.9 mm). When the tibial component was rotated 5 mm medially to the ATCPR, the knee ROM decreased in flexion with patellar subluxation, while it decreased in extension when rotated 5 mm laterally. This method identifies the ideal tibial tray rotation in TKA, at which maximal range of tibial rotation and knee ROM are achieved without obvious overriding of components. [Orthopedics, 2016; 39(3):S67-S71.].