A structured framework for standardized 3D leg alignment analysis: An international Delphi consensus study

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-04-16 DOI:10.1002/ksa.12676

Quinten W. T. Veerman, Gabriëlle J. M. Tuijthof, Nico Verdonschot, Reinoud W. Brouwer, Peter Verdonk, Annemieke van Haver, Hugo C. van der Veen, Peter A. J. Pijpker, Judith olde Heuvel, Roy A. G. Hoogeslag, the 3D Leg Alignment Consensus Expert Group

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引用次数: 0

Abstract

Purpose

To reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability.

Methods

A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement.

Results

Rounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion.

Conclusions

This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni- and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross-study comparability.

Level of Evidence

Level V.

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标准化3D腿部对齐分析的结构化框架：一项国际德尔菲共识研究。

目的：国际专家就基于三维骨模型的标准化三维腿部对齐分析的结构化框架达成共识，保证一致性，提高临床适用性。方法：采用德尔菲法进行4轮研究。第1轮和第2轮涉及指导和评级小组，该小组根据保留解剖结构3D复杂性的原则制定了声明，这些原则是通过系统回顾确定的。这些声明包含了导出关节中心和关节方向的方法，以及使用3D骨模型定义坐标系统的方法。在第三轮和第四轮中，一个由35名国际专家组成的小组，包括临床医生（54%）和工程师（46%），以及来自欧洲（80%）、大洋洲（9%）、亚洲（6%）和美洲（6%）的参与者，对这些陈述进行了评估。一致定义为≥80%的同意。结果：第1轮和第2轮产生了31个陈述，将被纳入调查。其中，26项声明在第三轮达成共识，其余5项声明在第四轮得到完善并达成共识。专家们同意利用所有可用的相关表面数据来定义关节中心、关节方向、单独的股骨和胫骨坐标系以及组合的腿部坐标系，并采用中心3D轴来确定股骨变形和胫骨扭转。结论：这项国际德尔菲共识研究为基于3D骨模型的标准化3D腿部对齐分析提供了一个结构化框架。该框架旨在提高膝周围单平面和多平面矫正截骨术术前规划和执行的临床适用性，减少3D腿部对齐分析文献的方法学差异，并提高交叉研究的可比性。证据等级：V级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).