Coronal plane alignment of the knee phenotypes distribution varies significantly as a function of geographic, osteoarthritic and sex-related factors: A systematic review and meta-analysis

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-05-19 DOI:10.1002/ksa.12704

Giancarlo Giurazza, Andrea Tanzilli, Edoardo Franceschetti, Stefano Campi, Pietro Gregori, Francesco Rosario Parisi, Michele Paciotti, Giovanni Perricone, Biagio Zampogna, Rocco Papalia

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Abstract

Purpose

The coronal plane alignment of the knee (CPAK) classification is a nine-phenotype matrix based on limb alignment and joint line obliquity. This study aimed to provide a global overview of CPAK distribution, hypothesising significant geographic, osteoarthritic and sex-related variations.

Methods

A systematic literature search (Embase, Medline/PubMed and Cochrane Library) following PRISMA guidelines was conducted, utilising the search terms “Coronal Plane Alignment of the Knee” OR “CPAK”. Studies considering image modalities other than long-leg radiographs were excluded. A random-effects meta-analysis of proportions was performed, and statistical significance was defined as p < 0.05.

Results

A total of 38 studies comprising 46,966 knees were analysed. The most common phenotypes worldwide were CPAK I (33.1%), II (25.9%) and III (14.4%) in the osteoarthritic population and CPAK II (34.9%), I (21.5%) and III (19.3%) in the healthy population. Among osteoarthritic populations, CPAK type I was predominant in Europe (29.2%), Asia (41.9%) and America (33.6%), type II in Australia (32.6%) and type III in Africa (28.6%). In healthy populations, type II was predominant in Europe (42.8%) and Asia (35.3%), whereas type I was most common in South America (44.8%). Significant regional differences were observed among both osteoarthritic and healthy knees, and between osteoarthritic and healthy knees in individual countries. In Europe, significant sex differences were observed in the distribution of types I (39.1% M; 23.5% F) and III (11.4% M; 24.6% F) in the osteoarthritic population, and in the distribution of types I (26.7% M; 9.4% F), II (43.9% M; 34.4% F) and III (11.3% M; 20.6% F) in the healthy population. In Asia, significant sex differences were found for type III in osteoarthritic knees (6.3% M; 11.4% F).

Conclusion

CPAK distribution varies significantly as a function of geographic, osteoarthritic, and sex-related factors. A personalised approach to TKA may be desirable to better accommodate these differences.

Level of Evidence

Level IV.

Abstract Image

查看原文本刊更多论文

膝关节表型分布的冠状面排列随着地理、骨关节炎和性别相关因素的功能而显著变化：一项系统回顾和荟萃分析。

目的：膝关节冠状面排列（CPAK）分类是一个基于肢体排列和关节线倾角的九表型矩阵。本研究旨在提供CPAK分布的全球概况，并假设显著的地理、骨关节炎和性别相关差异。方法：按照PRISMA指南进行系统文献检索（Embase、Medline/PubMed和Cochrane Library），检索词为“膝关节冠状面对齐”或“CPAK”。排除了考虑长腿x线片以外的图像形式的研究。对比例进行随机效应荟萃分析，统计学显著性定义为p。结果：共分析了38项研究，包括46,966个膝关节。世界范围内最常见的表型是骨关节炎人群中CPAK I（33.1%）、II（25.9%）和III(14.4%)，健康人群中CPAK II（34.9%）、I（21.5%）和III（19.3%）。在骨关节炎人群中，欧洲（29.2%）、亚洲（41.9%）和美洲（33.6%）以CPAK I型为主，澳大利亚（32.6%）以CPAK II型为主，非洲（28.6%）以CPAK III型为主。在健康人群中，II型在欧洲（42.8%）和亚洲（35.3%）占主导地位，而I型在南美洲最常见（44.8%）。在骨关节炎患者和健康膝关节之间，以及在个别国家骨关节炎患者和健康膝关节之间，观察到显著的区域差异。在欧洲，I型的分布存在显著的性别差异(39.1% M；23.5% F)和III (11.4% M；24.6% F)在骨关节炎人群中，I型分布(26.7% M；9.4% f), ii (43.9% m)；34.4% F)和III (11.3% M；20.6% F)。在亚洲，III型膝骨关节炎患者的性别差异显著(6.3%；11.4% F)。结论：CPAK的分布与地理、骨关节炎和性别相关因素有关。为了更好地适应这些差异，个性化的TKA方法可能是可取的。证据等级：四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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).