Bony alignment decisions affect patient-specific laxity phenotype patterns significantly, independent of the deformity

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-06-29 DOI:10.1002/ksa.12730

Heiko Graichen, George M. Avram, Francesco Zambianchi, Niklas M. Graichen, Fabio Catani, Sebastien Lustig, Michael T. Hirschmann

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引用次数: 0

Abstract

Purpose

While bony alignment phenotype reconstruction became an important part of personalised knee arthroplasty, the knowledge on laxity phenotypes (LPs) is still limited. This study aimed to calculate individual LPs and assess their changes based on bony decisions from different alignment workflows.

Methods

Radiographs and computer-assisted surgery data of 86 knees were imported into a validated knee alignment simulator. Individual bony parameters (medial proximal tibial angle, lateral distal femoral angle and posterior condyle axis) were first introduced. By that, the patient-specific bony phenotype (B-FKP) was implemented, and based on these simulations, the patient-specific laxity phenotype (L-FKP) was defined, calculated and analysed for the total group, as well as for all Coronal Plane Alignment of the Knee (CPAK) subgroups. CPAK I and IV were summarised as varus group; II and V as neutral, and III, VI and IX as valgus group. Identical calculations were then compared for the MA and L-FKP of both workflows. LP was calculated in both extension (L-FKPext) and flexion (L-FKPflex), and a pattern matrix was constructed for all possible L-FKP combinations, enabling a comprehensive distribution analysis. Statistical differences between subgroups and B-FKP and mechanical alignment (MA) workflows were calculated.

Results

B-FKP showed a minimal, non-significant difference for L-FKPext in all subgroups; however, a huge variability in L-FKP pattern analysis. In contrast, MA showed a significant difference for L-FKPext in all subgroups, with a high correlation between L-FKPext and hip–knee–ankle angle. While in MA, 98% of knees showed lateral laxity (L-FKPflex-latlax), in B-FKP, only 56% were L-FKPflex-latlax, with a large variability (31% L-FKPflex-neutr and 13% L-FKPflex-medlax).

Conclusions

Personalised bony resections reduce gap differences for LPext and LPflex independent of the deformity. MA showed a high correlation between deformity and LPext in extension and a uniform lateral laxity in flexion. L-FKP analysis can help to understand the individuality of knees from a soft tissue aspect.

Level of Evidence

Level III.

Abstract Image

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骨对齐决定显著影响患者特异性松弛表型模式，与畸形无关。

目的：虽然骨排列表型重建成为个体化膝关节置换术的重要组成部分，但对松弛表型（LPs）的了解仍然有限。本研究旨在计算单个lp，并根据不同对齐工作流程的骨骼决策评估其变化。方法：将86例膝关节的x线片和计算机辅助手术资料导入经验证的膝关节对齐模拟器。首先介绍了个体骨参数（胫骨内侧近端角、股骨外侧远端角和后髁轴）。通过这种方法，实现了患者特异性骨表型（B-FKP），并基于这些模拟，定义、计算和分析了患者特异性松弛表型（L-FKP），用于总组以及所有膝关节冠状面对齐（CPAK）亚组。CPAK I和IV组为内翻组；II、V组为中性组，III、VI、IX组为外翻组。然后对两个工作流的MA和L-FKP进行相同的计算比较。在伸展（L-FKPext）和屈曲（L-FKPflex）中计算LP，并构建所有可能的L-FKP组合的模式矩阵，从而进行全面的分布分析。计算亚组、B-FKP和机械对齐（MA）工作流程之间的统计差异。结果：B-FKP与l - fkpx在所有亚组中差异极小，无显著性差异；然而，在L-FKP模式分析中存在巨大的变异性。相比之下，MA在所有亚组中显示l - fkpx有显著差异，l - fkpx与髋关节-膝关节-踝关节角度高度相关。在MA中，98%的膝关节表现为外侧松弛（L-FKPflex-latlax），而在B-FKP中，只有56%的膝关节表现为L-FKPflex-latlax，且变异性很大（31%的膝关节表现为l - fkpflex - neutral， 13%的膝关节表现为L-FKPflex-medlax）。结论：个体化骨切除可减少LPext和LPflex的间隙差异，而不受畸形的影响。MA显示伸展时的畸形和lpex高度相关，屈曲时的均匀侧向松弛。L-FKP分析有助于从软组织角度了解膝关节的个体性。证据等级：三级。

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).