title: The "midsulcus line" as a landmark for tibial resection during total knee arthroplasty.
abstract: BACKGROUND
  Proper tibial alignment is an important goal of total knee arthroplasty. Most surgeons agree that tibial coronal alignment should be within three degrees of neutral mechanical alignment. The "midsulcus line" is a line drawn along the sulcus of the tibial spines, and then the line is continued in the sagittal plane and extended onto the anterior tibia where it intersects the tibial tubercle approximately 3 to 4mm lateral to the tubercle's medial border. The tibial cut was then made perpendicular to this line. The aim of our study was to assess, using CT scans, whether this line provided a consistent guide for planning the tibial cut in total knee arthroplasty.
  
  
  METHODS
  We reviewed the CT scans of the knees of 107 patients with osteoarthritis who had undergone a CT scan for planning of custom cutting guides. The midsulcus line was drawn on all scans.
  
  
  RESULTS
  We found that in 105 of 107 knees, a perpendicular cut to this tibial landmark would have delivered a cut surface within three degrees of neutral mechanical alignment.
  
  
  CONCLUSIONS
  The midsulcus line is a reliable landmark for planning the tibial resection in total knee arthroplasty.
  
  
  METHODS
  III.
authors.affiliation: The St. Joseph Medical Center, 7601 Osler Dr., Towson, MD 21204, United States. Electronic address: ddalury@gmail.com.
authors.forename: David F
authors.initials: DF
authors.lastname: Dalury
authors.affiliation: DePuy-Synthes Joint Reconstruction, 700 Orthopaedic Dr., Warsaw, IN 46582, United States.
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Aram
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D017760:Bone Malalignment / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Midsulcus line; Tibial alignment; Total knee arthroplasty