Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 122588

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : AC01 - AC07 Full Version

Comparison of Morphometric Data of Upper End of the Tibia between North and East Indian Populations: A Cross-sectional Study

Published: November 1, 2023 | DOI:
Nidhi Lal, Ankita Saha, Shavi Garg, Prachi Saffar Aneja

1. Associate Professor, Department of Anatomy, FMHS, SGT University, Gurugram, Haryana, India. 2. Senior Resident, Department of Anatomy, Sarat Chandra Chattopadhyay Government Medical College and Hospital, Uluberia, West Bengal, India. 3. Assistant Professor, Department of Anatomy, Shri Atal Bihari Vajpayee Government Medical College, Faridabad, Haryana, India. 4. Professor and Head, Department of Anatomy, FMHS, SGT University, Gurugram, Haryana, India.

Correspondence Address :
Ankita Saha,
Flat No. 539, Railvihar, Anandapur, Kolkata-700107, West Bengal, India.


Introduction: Knee joint problems, such as Osteoarthritis (OA), primarily affect the upper weight-bearing end of the tibia. Total and unicompartmental knee arthroplasty are commonly performed as treatment options. However, existing studies on morphometric assessment of the knee joint mainly focus on the Western population, with a lack of data among the Indian population. Obtaining such data is crucial for designing tibial components of knee prostheses tailored to the Indian population.

Aim: To compare the morphometric data of the upper end of the tibia between the North and East Indian populations.

Materials and Methods: A cross-sectional observational study was conducted in the Department of Anatomy at FMHS Medical College, SGT University, Gurugram, Haryana, North India, involving 41 dry tibias, and at Medical College and Hospital Kolkata in East India, involving 43 dry tibias. Measurements of the Anteroposterior (AP) and Transverse Diameters (TD) of the Medial Tibial Condyle (MTC), Lateral Tibial Condyle (LTC), and Total Tibial Condyles (TTC) were performed using digital Vernier callipers with a least count of 0.01 mm. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) (version 21.0), and Student’s t-test was applied, with p<0.05 considered significant.

Results: The mean TD and AP diameters of the tibial plateau were found to be greater in the East Indian population (TD: 65.47±5.46, AP: 44.29±4.36). In both samples, the AP diameter of MTC (North Indians: 38.30±3.54, East Indians: 40.63±3.46) was greater than that of LTC (North samples: 35.30±3.51, East samples: 35.70±3.96). When comparing parameters between the North and East samples using Student’s t-test, significant differences were found on the right-side for the mean AP (p-value=0.0065) and TD (p-value=0.0213) of TTC, mean AP (p-value=0.0006) and TD (p-value=0.0219) of MTC, mean TD of LTC (p-value=0.0002), mean AP (p-value=0.0005) and TD (p<0.0001) of the Intercondylar area at anterior ends, and mean AP (p<0.0001) and TD (p-value=0.0017) of the Intercondylar area at posterior ends. On the left-side, significant differences between the North and East population were found for mean TD of LTC (p-value=0.0348), AP (p<0.0001) and TD (p-value=0.0207) of the Intercondylar area posterior end. When comparing the areas between the North and East populations, significant differences were found on the right-side only for the MTC (p-value=0.0013), LTC (p-value=0.0083), and TTC (p-value=0.0055).

Conclusion: There are significant regional variations in the anthropometric measurements of the North and East Indian populations, emphasising the need to develop population-specific tibial prostheses for improved surgical outcomes.


Condyle, Osteoarthritis, Prosthesis, Surgical outcomes

Cases of early-age OA of the knee are on the rise, and the condition worsens with old age. OA is a common indicator for Total Knee Arthroplasty (TKA) (1). The World Health Organisation (WHO) studied the prevalence of OA from 1998 to 2015 and found that the number of OA cases is increasing by 10-15% every year. Along with it, the burden of musculoskeletal disability is also on the rise (2). The knee joint is the largest synovial joint in the human body, consisting of two femorotibial articulations between the lateral and medial condyles of each bone, as well as one femoropatellar articulation.

The proximal end of the tibia bone widens to form medial and lateral condyles. The medial condyle is comparatively larger and ovoid, while the lateral condyle is smaller and circular (3). The articular surfaces of the upper end are separated by an intercondylar eminence, which is surrounded by relatively rough anterior and posterior intercondylar areas. The tibial intercondylar tubercles and areas provide attachment for the menisci, which are the principal ligaments of the knee that hold the femur and tibia together (4). The relatively incongruent nature of the joint space makes the knee joint inherently mobile. Proper interaction between the articular surfaces of the knee joint is necessary for movement and locomotion. Therefore, knowledge of the morphometry of the articular surfaces of both the upper and lower ends of the tibia is important (5).

Morphometric measurements of the tibia are very close to the living state, as it resists erosive forces and maintains its anatomical shape for a longer time (6). Zalawadia AZ and Patel SM, mentioned that obesity is one of the important causes of the high incidence of OA (7). Total knee replacement surgery can be beneficial for reducing pain and improving the lifestyle of patients with severe OA. However, a mismatch of the selected prosthesis may lead to severe complications such as cruciate ligament rupture, limited movement of the knee joint after surgery, and even loosening of the prosthesis. Therefore, knee prostheses made according to morphometric data of the femur and tibia will yield excellent results and fewer postoperative complications.

Total knee replacement surgery includes a resurfacing and realignment procedure to produce a pain-free and stable knee. In TKA, less than half an inch (9 mm) of the tibial and femoral articular surfaces are removed from the ends of the bones and replaced with metal and plastic caps (8). The dimensions of each condyle are prerequisites for designing a prosthesis for TKA. Proper knowledge of the anatomy of the tibial condyles helps in designing an appropriate prosthesis to prevent loosening after surgery (9).

A successful outcome in TKA depends on precise bone cutting, appropriate soft tissue balancing, and maximum tibial bone coverage with a suitable implant size (10). Proper prosthesis design also corrects varus and valgus deformities of the knee (11). Recent studies show that revision surgery is often required after TKA to correct aseptic loosening of the implant. Implant stability can be influenced by various factors, one of which is the characteristics of the prosthesis design (12). Orthopaedicians avoid using implants with incomplete coverage of the tibia during surgery as this may cause the implant to collapse (13).

The morphology of the tibial component of the prosthesis should match the resected surface in order to restore stability and ensure proper load transmission after knee replacement surgery (14). Earlier, various studies were conducted on the measurement of different parameters of the tibial plateau (15),(16),(17),(18),(19),(20), but none focused on subpopulation variations. Anthropometry varies widely among different populations around the world. Indians and Chinese generally have a smaller build and stature compared to Western populations. It is likely that Indians may be at risk of component oversizing in TKA with most commercially available prosthesis (21). To ensure better compatibility, population-specific appropriate sizing is required.

Very few studies have been conducted on the anthropometry of the proximal tibia in the Indian population (1),(9),(22). The present study was conducted separately in Gurugram and West Bengal, as differences in stature are often observed among people originating from these two places. For the present study, cadaveric tibia bones from the North and East Indian populations were considered due to the availability of both. The aim of the present study was to investigate any regional variations in the tibial plateau among these two population samples and to apply the collected data in designing a suitable tibial component for knee prostheses for the Indian population, focusing on these two subpopulations.

Material and Methods

A cross-sectional observational study was conducted in the Department of Anatomy at FMHS, SGT University in Gurugram and Medical College and Hospital in Kolkata, West Bengal, India from May 2021 to June 2022. The study focused on dry cadaveric tibia bones, with no involvement of patients or animals.

Inclusion and Exclusion criteria: Only fully ossified, processed, grossly normal, and completely dry tibias were considered for the study. Tibia bones that were damaged, broken, improperly processed, or showing gross malformations were excluded.

Sample size calculation: The sample size was calculated using the formula (23):


Here, ‘n’ is the sample size, Z is the statistic corresponding to the level of confidence (95% confidence level corresponds to Z=1.96), ‘P’ is the expected prevalence (50%), and ‘d’ is the desired precision (11%). The estimated sample size calculated using these values was 80.

Study Procedure

A total of 84 dry adult cadaveric tibias (42 right and 42 left) were studied, regardless of sex. Among these, 43 tibias (22 right and 21 left) from the East Indian population were studied at Medical College and Hospital in Kolkata, while 41 tibias (20 right and 21 left) from the North Indian population were studied at FMHS, SGT University in Gurugram.

Each tibia was assigned a serial number. Measurements were taken by using digital Vernier callipers (CT-ZT-VERNIER by zhart) as shown in (Table/Fig 1) with a least count of 0.01 mm. Three readings were taken for each sample. All the measurements taken are shown in (Table/Fig 2) which includes total AP diameter, total (TD) of TTC, AP and TD of MTC, LTC and Intercondylar area.

The area of the TTC was measured using the formula:

Area of condyle=AP×TD of condyle (9).

The areas of the MTC and LTCs were measured separately and statistically analysed.

The aspect ratio was calculated using the formula:

Aspect ratio=TD/AP×100 (22).

Statistical Analysis

The data was statistically analysed using SPSS (version 21.0) software. Measured variables were presented as mean, range and Standard Deviation (SD). The data was tabulated, and in order to compare the two populations, a Student’s t-test was applied, with a p-value of <0.05 considered statistically significant.


In the present study, various parameters of the tibial plateau, such as the AP and TD of the TTC, MTC, LTC, and the Intercondylar Area (ICA) (anterior end, middle, and posterior end), were observed and compared between the North and East Indian populations.

The North Indian samples (Table/Fig 3) showed that the mean AP diameter of the MTC (38.30±3.54 mm) was slightly greater than that of the LTC (35.30±3.51 mm), but the mean TD was almost similar in both condyles. Both the TD (21.78±2.82 mm) and AP (26.04±2.21 mm) of the anterior intercondylar area were found to be greater than those of the posterior intercondylar area. The area of the TTC was slightly larger on the left-side (2722 mm2) than on the right-side (2669 mm2).

In the East Indian samples (Table/Fig 3), the mean AP diameter of the MTC (40.63±3.46) was significantly higher than that of the LTC (35.70±3.96), but the mean TD was almost similar in both condyles. The mean AP diameter of the anterior intercondylar area (28.31±2.86) was greater than that of the posterior intercondylar area (22.11±3.24). The TD of the anterior and posterior intercondylar areas was almost similar. The area of the TTC was significantly larger on the right-side (3025 mm2) compared to the left-side (2805 mm2). The area of each condyle was calculated by multiplying the AP diameter and TD (AP×TD) of each condyle (Table/Fig 3). The total area summation of the North Indian samples (41 samples) was 110559.87 mm2. The mean area of the North Indian samples was 2696±338.89. The total area summation of the East Indian samples (43 samples) was 125483.92 mm2. The mean area of the East Indian samples was 2918±491.13.

The aspect ratio (TD/AP×100), which defines the relationship between the TD and AP diameter, was calculated as it helps anticipate the shape of the tibial component of the prosthesis. The aspect ratio (Table/Fig 3) for the North Indian population was 1.49±0.08, while for the East Indian population, it was 1.48±0.09. A comparison of the parameters of the North and East Indian population samples is given in (Table/Fig 4),(Table/Fig 5),(Table/Fig 6). From (Table/Fig 4), it can be seen that the mean AP (p-value=0.0065) and TD (p-value=0.0213) of the TTC were found to be significant when comparing between the North and East populations on the right-side. In the case of the medial condyle, only on the right-side, the mean AP (p-value=0.0006) and TD (p-value=0.0219) of the North and East samples were found to be significant in comparison. For the lateral condyle, the mean TD of the North and East samples was found to be significant on both sides (right-side p-value=0.0002 and left-side p-value=0.0348).

From (Table/Fig 5), it can be observed that the mean AP diameter of the intercondylar area at the anterior end was significantly on both sides when comparing both samples. The mean TD of the intercondylar area at the anterior end was highly significant when comparing between the North and East samples on both sides (p-value <0.0001). Similarly, the TD of the intercondylar area at the posterior end was found to be significant on both sides (right p-value=0.0017, left p-value=0.0207) when comparing between the North and East samples. The mean TD of the middle intercondylar area was found to be significant only on the left-side (p-value=0.0173).

In (Table/Fig 6), the areas of tibial condyles were compared between the North and East samples. The results were found to be significant only on the right-side for the medial condyle (p-value=0.0013), lateral condyle (p-value=0.0083), and TTC (p-value=0.0055).


With the increase in sedentary lifestyles and lack of exercise, knee joint diseases, especially OA, have become very common worldwide. As a result, the demand for knee joint replacement surgeries like uni-compartmental and TKA is also rising. However, the prostheses types currently available in the market are best suited for the Western and Caucasian population, whereas Asians, including Indians, generally have a smaller stature compared to tall and robust Caucasians.

Pandit R and Sharma N, and Nayak G et al., found significant results for the AP diameter of the lateral condyle in right and left comparisons (24),(25). However, in the present study, right and left-side comparisons did not show significant results when compared for each population. When the right and left-side comparison was performed between the North and East populations using a student’s t-test, it was found to be significant for the medial condyle, both AP diameter (0.0006) and TD (0.0219) on the right-side, Lateral condyle TD (0.0002) on the right-side, and TTC, both AP (0.0065) and TD (0.0213) on the right-side (Table/Fig 4).

A comparison of the size of Indian knees (North and East Indian population) with other studies was conducted internationally (Table/Fig 7) (15),(16),(17),(18),(19),(20),(26),(27); and nationally (Table/Fig 8) to determine the exact size of knee implants that will fit Indians better (1),(9),(22),(25),(28),(29),(30),(31).

Upon comparing the present study findings with those of other nationalities (Table/Fig 7), authors observed that all the morphometric measurements of the proximal tibia in the present study population were smaller than those reported in other studies, except for the study conducted by Yue B et al., (26). This suggests that Indian knees are generally smaller than knees from other populations worldwide. A consistent finding across all studies was that the total TD was higher than the total AP diameter of the upper end of the tibia.

Yue B et al., discovered in their study that Chinese knees are smaller than White knees (26). When comparing their study to the present, authors found that the total TD was higher, but the total AP diameter was smaller in the study conducted by Yue B et al., (26). Mohan H et al., conducted a study on 100 non arthritic Indian knees using Magnetic Resonance Imaging (MRI) and found that Indian knees were smaller than Chinese knees (only in terms of TD) as well as Caucasian and Hispanic knees (both in terms of AP and TD) (32). This finding aligns with the study conducted by Mohan H et al., albeit using dry cadaveric tibias (32).

Multiple authors have reported that Asian knees, including Indian knees, are generally smaller than Caucasian knees (15),(27). Consequently, Asians with their smaller skeletal profile would require smaller-sized knee prostheses. According to the study by Mahoney OM and Kinsey T a mismatch in the size of the resected bony surface and the prosthesis can lead to overhanging or undercoverage of the implant, resulting in poor surgical outcomes (33). The optimal solution to this problem is to design TKA implants that cater to different populations. Such customised implants would provide better anatomical conformity, improved fitting and coverage, enhanced gait patterns, favourable long-term outcomes, and restoration of normal knee biomechanics.

In TKA, the tibial component is more susceptible to complications than the femoral component (34). Overhanging of the tibial component can cause instability, soft tissue irritation, and knee pain, particularly on the medial side (33). Similarly, underhanging of the tibial component can lead to aseptic loosening due to increased tibial bone resorption (35).

Most of the total knee prostheses currently available have been developed based on measurements from Caucasians. However, Caucasian knees are generally larger than Asian knees (36).

Therefore, for Indians, authors need population-specific knee implants that will provide a better quality of life after knee surgery.

In the present study, the aspect ratio was calculated to anticipate the shape of the tibial component of the prosthesis. It was found that the aspect ratio in Indians is higher than that of Caucasians but lower than that of the Chinese, Thai population, Iranians, and Koreans (15),(17),(18),(19),(27).

When the aspect ratio is 100%, it indicates that the total TD equals the AP diameter, and the symmetric tibial component is circular in shape. However, when the aspect ratio is above 100%, it indicates a transversely oval tibial component (22). In the present study, the aspect ratio for the North samples was 1.49±0.08, and for the East samples, it was 1.48±0.09 (Table/Fig 3). The study also found a higher aspect ratio for smaller AP diameter and a lower aspect ratio for larger AP diameter. Therefore, the tibial component becomes more oval with a decrease in AP diameter and vice versa.

These findings on aspect ratio are similar to the studies conducted by Cheng FB et al., Ahmad N et al., and Kwak DS et al., (15),(22),(27). Hence, the available tibial prostheses in the market will not suit Asians, including Indians. This is because the implants have a constant condylar aspect ratio or show an increase in aspect ratio with increased AP diameter (37). Therefore, Indians require a tibial prosthesis that ensures good tibial implant coverage and shows a decrease in tibial aspect ratio with an increase in AP diameter.

(Table/Fig 8), the present study’s findings are compared with those of other Indian authors to determine whether a similar prosthesis size is required for all Indian populations or if it will vary regionally. In the present study, the AP diameter and TD of the medial condyle were greater on the right-side compared to the lateral condyle. However, on the left-side, the total TD of the lateral condyle was higher than that of the medial condyle. This finding does not align with many other Indian studies that report greater anthropometric measurements of both AP and TD for the medial condyle than the lateral condyle (22),(28),(29).

Prostheses specific to the Indian population are required, taking into account regional variations. The present study reveals that the East Indian population has higher measurements compared to the North Indian population, indicating the need for smaller prostheses for North Indians.

In general, the total TD and AP diameter are used to select the implant size and determine the ideal tibial component required. Pooja B et al., conducted a study on the proximal end of the tibial condyle in the North Indian population (1). They found that the total TD on the right-side was 63.38±4.23 mm and on the left-side was 63.88±5.32 mm. The total AP diameter on the right-side was 40.96±4.24 mm, and on the left-side was 42.88±4.38 mm. These findings align closely with the study conducted by Pooja B et al., (1).

However, these study findings are smaller than those reported by Ahmad N et al., who also measured the tibial plateau of North Indians (22). Ahmad N et al., found that the total TD on the right-side was 66.03±6.60 mm and on the left-side was 66.72±5.13 mm. The total AP diameter on the right-side was 42.24±5.12 mm, and on the left-side was 42.89±4.38 mm.

Bamne A and Gayathri UP conducted a study on the Central Indian population and reported a total TD on the right-side of 63.89±7.29 mm and on the left-side of 66.22±4.38 mm (30). The total AP diameter on the right-side was 43.58±3.89 mm, and on the left-side was 45.12±3.66 mm. These findings were generally lower than those of Bamne A and Gayathri UP except for the total AP diameter on the right-side (30).

Anthropometric measurements of the intercondylar area were studied and compared with the findings of other authors in [Table/Fig-9,10] (1),(8),(22),(25),(28),(29). When compared with other Indian studies (Table/Fig 9), the present study found that the AP diameter of the intercondylar area in the East Indian samples was higher than that of the South and North Indian populations. The AP measurement of the intercondylar area in the North Indian samples of the present study was smaller than the findings of other studies conducted on the same population.

In the measurement of the tibial plateau, the TD of the intercondylar area was found to be largest in the anterior end, followed by the posterior end, and the middle part had the smallest measurement in both populations under study. The TD of the intercondylar area on both sides was found to be smaller in the East Indian samples. Therefore, among all the measurements of the tibial plateau, only the TD of the intercondylar area was found to be smaller in the East Indian population.

When comparing these study findings on the TD of the intercondylar area with other Indian authors (Table/Fig 10), the measurements of the East Indian samples were found to be the smallest among all. The measurement of the TD of the intercondylar area among the North Indian samples was found to be greater than the study conducted by Chaitra D et al., on the South Indian population but smaller than the findings of other authors (29). According to Bellemans J et al., the morphology of the knee joint has been proven to vary considerably among various ethnic groups, genders, and morphotypes of patients (36). Having normative data for a specific population subset is important as it helps design knee joint prostheses that provide the best fit and size for the knees.

Hence, the mean values of all the measurements of the tibial plateau in the present study would be helpful in manufacturing the tibial component of a knee prosthesis for the Indian population while accounting for regional variations.

When calculating the area (in mm2) of the TTC (APxTD), the North samples showed 2669.6+276.5 on the right-side and 2722.2+387.38 on the left-side. Much higher values were found in the East samples, with 3025.68+473.24 on the right-side and 2805.6+484.26 on the left-side (Table/Fig 6).

Pooja B et al., conducted a study on the North Indian population and found the total area (in mm2) on the right-side of male tibias to be 2559.12+301.6 and on the left-side 2675.39+353.8 (1). The total tibial area (in mm2) on the right-side of female tibias was 2599.34+332.7 and on the left-side was 2664.63+377.9. The findings of the present study in the North Indian population are higher than those of Pooja B et al., (1).

In the present study (Table/Fig 6), the area covered by the medial condyle on the right-side was found to be 41.92% in North Indian samples and 62.20% in East Indian samples. On the left-side, it was 38.29% in North Indian samples and 60.33% in East Indian samples. The area covered by the Lateral Condyle in this study was found to be 39.22% in North samples and 55.83% in East samples on the right-side. On the left-side, the area covered by the Lateral Condyle was found to be 35.56% and 58.81% in North and East samples, respectively.

Malegaonkar SS et al., conducted a study on 60 dry tibias (32 Right and 28 Left) in South India and found that the area covered by the MTC on the right-side was 41.57% and on the left-side was 40.76% (39). The area covered by the LTC on the right-side was 36.84% and on the left-side was 35.38% of the total condylar area. On comparison, it is seen that the findings in the East samples in this study are much higher, while the North sample findings are quite similar to the study of Malegaonkar SS et al., (38).

A recent study by Agichani SR et al., on 80 dry tibias in central India showed that the mean AP diameter of the medial condyle was 39.25±3.92 mm, and for the lateral condyle, it was 35.43±2.70 mm (39). The mean TD of the medial condyle was 27.99±3.27 mm, and for the lateral condyle, it was 27.00±2.09 mm. A comparison of the AP diameter of the medial condyle revealed that the Eastern samples in this study had much higher values, while the Northern samples showed much lower values than the findings of Agichani SR et al., (39).

Thakur A et al., conducted a study on 500 dry tibia bones (250 right, 250 left) collected from the population of Rajasthan, India (31). They compared their study findings with Western studies and found striking variations in knee morphology between the Asian and Western populations. In their study, the results showed that the mean AP diameter of the medial condyle on the right-side was 41.71±4.37 mm and on the left-side was 42.24±4.05 mm. The TD on the right-side was 29.28±2.87 mm, and on the left-side, it was 29.69±2.95 mm. For the lateral condyle, the mean AP diameter on the right-side was 37.6±3.35 mm and on the left-side was 36.93±3.44 mm. The TD on the right-side was 29.69±3.10 mm, and on the left-side, it was 30.16±2.94 mm. They also calculated the area (mm2) and found that the area of the medial condyle on the right-side was 1229.75±225.01 mm2 and on the left-side was 1261.59±218.73 mm². For the lateral condyle, the area on the right-side was 1123.91±199.79 mm2, and on the left-side, it was 1119.43±184.88 mm2. The lateral condyle dimensions in the study of Thakur A et al., were found to be much higher than the findings of the previous study [31,39]. Similarly, when comparing the medial condyle, it was found that the parameters of the Northern samples in the present study were lower, while the dimensions of the Eastern samples were closer to the results of the study by Thakur A et al., (31). When comparing the areas, all parameters were higher in the study by Thakur A et al., (31).

Therefore, the implant sizes designed for the Western population will not be suitable for Asians, and there are also regional variations among Indians. This study by Rodriguez-Merchan EC highlights the importance of information on the morphometry of the proximal articular surface of the tibia for orthopaedic surgeons (40). Current challenges in knee prosthetic design revolve around attempting to produce normal kinematics, decrease wear and tear, and achieve greater longevity.


Only right and left-side comparisons were possible, and sex differentiation has not been considered. Although the cadaveric bones used in the present study belonged to the respective regions, the chances of the bones belonging to a migratory class of people can’t be ruled out, although the possibility of this is slim. The present study was performed on dry bones, which may have undergone shrinkage in their morphology compared to live specimens. Tibial diameters beyond the various parameters taken in the present study need further investigation in this area.


The morphometric data in the present study reveal ethnic variations. Available tibial implants are designed based on dimensions of Western populations and may lead to a size mismatch when used for the Indian population. The data obtained from the present study will help in designing appropriately size-matched unicompartmental and total knee prostheses for Indians, with a focus on the North and East populations. This detailed study on measurements of the tibial plateau is not only helpful for orthopaedic surgeons but also beneficial to physical anthropologists, forensic experts, clinical anatomists, and medical students.


Pooja B, Babita P, Sabita M. Morphometric study of proximal end of tibia with its clinical implications in North Indian population. J Evolution Med Dent Sci. 2018;7(23):2801-06. [crossref]
Kim TK, Phillips M, Bhandari M, Watson J, Malhotra R. What differences in morphologic features of the knee exist among patients of various races? A systematic review. Clinical Orthopaedics and Related Research. 2017;475(1):170-82. [crossref][PubMed]
Servien E, Saffarini M, Lustig S, Chomel S, Neyret P. Lateral versus medial tibial plateau: Morphometric analysis and adaptability with current tibial component design. Knee Surg Sports Traumatol Arthrosc. 2008;16(12):1141-45. [crossref]
Moore KL, Dalley AF, Agur AMR. Clinically oriented Anatomy. 6 th edition. Lippicott Williams & Wilkins 2010. Pp- 520-21.
Standring S. Gray’s Anatomy. The anatomical basis of clinical practice. 39th edition. Elsevier/Churchill Livingstone 2005: Pp. 1436-37.
Ashley GT. Human sternum- influence of sex and age on its measurement. J Forensic Med. 1956;3:27-43.
Zalawadia AZ, Patel SM. Morphometric study of upper end of tibia in Gujarat region and its clinical implication in knee arthroplasty. Int J Anat Res. 2018;6(1.1):4871-75. [crossref]
Gandhi S, Singla R, Kullar J, Suri R, Mehta V. Morphometric analysis of upper end of Tibia. J Clin Diagn Res. 2014;8(8):10-13. [crossref][PubMed]
Srivastava A, Yadav A, Thomas RJ, Gupta N. Morphometric study of tibial condylar area in the north Indian population. J Med Sci Clin Res. 2014;2(3):515-19.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;248:13-14. [crossref]
Cuckler JM. Correcting extra-articular deformity of the knee: Acting in tandem. Orthopedics. 2007;30(9):774-76. [crossref][PubMed]
Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774-78. [crossref][PubMed]
Bohm I, Landsiedl F. Revision surgery after failed unicompartmental knee arthroplasty: A study of 35 cases. J Arthroplasty. 2000;15(8):982-89. [crossref][PubMed]
Surendran S, Kwak DS, Lee UY, Park SE, Gopinathan P, Han SH, et al. Anthropometry of the medial tibial condyle to design the tibial component for unicondylar knee arthroplasty for the Korean population. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):436-42. [crossref]
Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, et al. Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee. 2009;16(5):341-47. [crossref][PubMed]
Erkocak OF, Kucukdurmaz F, Sayar S, Erdil ME, Ceylan HH, Tuncay I. Anthropometric measurement of tibial plateau and correlationwith the current tibial implants. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):2990-97. [crossref][PubMed]
Phombut C, Rooppakhun S, Sindhupakorn B. Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population. J Exp Orthop. 2021;8(1):118. [crossref][PubMed]
Dai Y, Bischoff JE. Comprehensive assessment of tibial plateaumorphology in total knee arthroplasty: Influence of shape and size on anthropometric variability. J Orthop Res. 2013;31(10):1643-52. [crossref][PubMed]
Karimi E, Zandi R, Norouzian M, Birjandinejad A. Correlation of anthropometric measurements of proximal tibia in Iranian knees with size of current Tibial implants. Arch Bone Jt Surg. 2019;7(4):339-45.
Eboh DEO. Morphometric anatomy of the tibia plateau in Nigerians. Ethiop J Health Sci. 2022;32(1):155-60.
Crockarell JR Jr, Guyton JL. Arthroplasty of the knee. In: Canale ST, Beaty JH, eds.Campbell’s Operative Orthopaedics. 11th ed. Vol 1. Philadelphia: Mosby Elsevier; 2008:256-57.
Ahmad N, Singh D, Dubey A, Jethani SL. Morphometric analysis of proximal end of the tibia. National Journal of Clinical Anatomy. 2019;8:82-86. [crossref]
Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14-17.
Pandit R, Sharma N. Morphometric analysis of superior articular surface of tibia in dry cadaveric bones. JCMS Nepal. 2019;15(4):287-90. [crossref]
Nayak G, Panda SK, Chinara PK. Morphometric analysis of tibial plateau. Int J Res Med Sci. 2019;7(4):1261-64. [crossref]
Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G. Differences of knee anthropometry between Chinese and white men and women. The Journal of Arthroplasty. 2011;26(1):124-30. [crossref][PubMed]
Kwak DS, Surendran S, Pengatteeri YH, Park SE, Choi KN, Gopinathan P, et al. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007;14(4):295-300. [crossref][PubMed]
Reeti R, Akhtar MJ, Kumar B, Sinha RR, Kumar A. Morphometric study of upper end of tibia and its implications in total knee replacement. Indian J Clin Anat Physiol. 2021;8(3):213-18. [crossref]
Chaitra D, Pai D, Rathnakar P, Remya K. Morphometric study of upper end of tibia in dakshina Kannada population. Journal of Evolution of Medical and Dental Sciences. 2020;9(15):1252-55. [crossref]
Bamne A, Gayathri UP. A study on morphometric dimensions of tibial condyles in Indian population. Indian J Clin Anat Physiol. 2020;7(3):280-84. [crossref]
Thakur A, Bose P, Bang S. Morphometric study of Condylar plateau of tibia in Rajasthan population and it’s clinical implication in knee arthroplasty. Global Journal for Research Analysis. 2018;7(12):79-81.
Mohan H, Chhabria P, Bagaria V, Tadepalli K, Naik L, Kulkarni R. Anthropometry of Non-arthritic Asian knees: Is it time for a race-specific knee implant? Clin Orthop Surg. 2020;12(2):158-65.[crossref][PubMed]
Mahoney OM, Kinsey T. Overhang of the femoral component in total knee arthroplasty: Risk factors and clinical consequences. J Bone Joint Surg Am. 2010;92(5):1115-21. [crossref][PubMed]
Canale ST. Campbell’s Operative Orthopaedics, 10 th edn. Mosby Publishing, Philadelphia, 2003.
Gu S, Kuriyama S, Nakamura S, Nishitani K, Ito H, Matsuda S. Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1270-79. [crossref][PubMed]
Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J. The John Insall Award: Both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res. 2010;468(1):29-36. [crossref][PubMed]
Hitt K, Shurman JR 2 nd, Greene K, McCarthy J, Moskal J, Hoeman T, et al. Anthropometric measurements of the human knee: Correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003;85(A Suppl 4):115-22. [crossref]
Malegaonkar SS, Naik DB, Shireen S. A morphometric study of the proximal end of tibia in north east Karnataka population with its clinical implication. Indian Journal of Anatomy. 2017;6(1):81-85.
Agichani SR, Medhi B, Harioudh SK. A cross-sectional study to assess morphometry of upper end of 80 cadaveric tibiae in a tertiary care centre of central India. J Evid Based Med Healthc. 2021;8(30):2714-18. [crossref]
Rodriguez-Merchan EC. Instability following total knee arthroplasty. Hospital for Special Surgery Journal. 2011;7(3):273-78.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/64420.18627

Date of Submission: Apr 04, 2023
Date of Peer Review: Jun 15, 2023
Date of Acceptance: Oct 05, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Apr 08, 2023
• Manual Googling: Jul 06, 2023
• iThenticate Software: Oct 03, 2023 (16%)

ETYMOLOGY: Author Origin


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)