{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:00:15Z","timestamp":1773270015790,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T00:00:00Z","timestamp":1531267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T00:00:00Z","timestamp":1531267200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi\u2019s Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi\u2019s Line; and (3) extra\u2010articular bony landmarks might influence the variability of the anteroposterior axis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three\u2010dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi\u2019s Line, Axis MED, Axis 1\/6MED, Axis 1\/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average rotational mismatch angles (referring to the projected anatomical\/surgical epicondylar axes) were \u2212\u20092.7\u00b0\u2009\u00b1\u20095.8\u00b0\/1.0\u00b0\u2009\u00b1\u20096.0\u00b0 (Akagi\u2019s Line), \u2212\u20094.2\u00b0\u2009\u00b1\u20097.7\u00b0\/\u2212\u20090.5\u00b0\u2009\u00b1\u20097.8\u00b0, 2.9\u00b0\u2009\u00b1\u20097.2\u00b0\/6.6\u00b0\u2009\u00b1\u20097.2\u00b0, 9.8\u00b0\u2009\u00b1\u20097.0\u00b0\/13.5\u00b0\u2009\u00b1\u20096.8\u00b0 (Axis MED, Axis 1\/6MED, Axis 1\/3MED), \u2212\u20095.1\u00b0\u2009\u00b1\u20097.9\u00b0\/\u2212\u20091.4\u00b0\u2009\u00b1\u20097.8\u00b0 (Axis of Oval Shape), and 19.3\u2009\u00b1\u20099.5\u00b0\/23.0\u00b0\u2009\u00b1\u20099.6\u00b0, \u2212\u20092.0\u00b0\u2009\u00b1\u200911.3\u00b0\/1.7\u00b0\u2009\u00b1\u200911.4\u00b0 (Axis Anterior Crest, Axis Second Metatarsus), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Akagi\u2019s Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1\/6MED and Axis MED are good substitutes for Akagi\u2019s Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra\u2010articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Levels of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5052-x","type":"journal-article","created":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T00:23:18Z","timestamp":1531268598000},"page":"1570-1579","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Bony landmarks with tibial cutting surface are useful to avoid rotational mismatch in total knee arthroplasty"],"prefix":"10.1002","volume":"27","author":[{"given":"Yuan","family":"Ma","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Mizu\u2010uchi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuro","family":"Ushio","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Hamai","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukio","family":"Akasaki","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Murakami","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuharu","family":"Nakashima","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Graduate School of Medical Sciences Kyushu University 3\u20101\u20101 Maidashi, Higashi\u2010ku 812\u20108582 Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,11]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010008\u20100452\u20108"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000160027.52481.32"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200403000\u201000030"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2004.08.005"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.11138\/jts\/2013.1.4.1455"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199301000-00008"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2010.03.015"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.90B8.19905"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.22410"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200108000\u201000021"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/717546"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.93B5.25893"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010013\u20102468\u20101"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.15.1.55"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.96B11.33794"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010017\u20101609\u2010y"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010013\u20102097\u20109"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.06.016"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010009\u20100983\u2010x"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2005.04.001"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010017\u20102828\u20102"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2010.08.002"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.90B8.20265"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.08.004"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.01.002"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.06.055"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20103370\u20101"},{"key":"e_1_2_10_29_2","first-page":"172","article-title":"Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review","volume":"436","author":"Panni AS","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2007.11.021"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20100924-05"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200209000\u201000018"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.09.003"},{"key":"e_1_2_10_34_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2015.1022438"},{"issue":"2","key":"e_1_2_10_35_2","first-page":"52","article-title":"What should the surgeon aim for when performing computer\u2010assisted total knee arthroplasty?","volume":"87","author":"Van Damme G","year":"2005","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_10_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010012\u20102269\u2010y"},{"key":"e_1_2_10_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097\u20100258(19980115)17:1<101::AID\u2010SIM727>3.0.CO;2\u2010E"},{"key":"e_1_2_10_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010014\u20100565\u20108"},{"key":"e_1_2_10_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11420\u2010016\u20109491\u2010y"},{"key":"e_1_2_10_40_2","first-page":"884","article-title":"Research on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty","volume":"28","author":"Yu HC","year":"2015","journal-title":"Zhongguo Gu Shang"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-018-5052-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00167-018-5052-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-018-5052-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-018-5052-x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T10:09:14Z","timestamp":1760868554000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-018-5052-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,11]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1007\/s00167-018-5052-x"],"URL":"https:\/\/doi.org\/10.1007\/s00167-018-5052-x","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,11]]},"assertion":[{"value":"16 February 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The author declares that there is no competing interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The institutional ethics committee approved all data-collection (Kyushu University, IRB ID of the Approval: 25\u201374).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All subjects provided informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}