Heiko Graichen, George M. Avram, Francesco Zambianchi, Niklas M. Graichen, Fabio Catani, Sebastien Lustig, Michael T. Hirschmann
{"title":"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。","authors":"Heiko Graichen, George M. Avram, Francesco Zambianchi, Niklas M. Graichen, Fabio Catani, Sebastien Lustig, Michael T. Hirschmann","doi":"10.1002/ksa.12730","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3637-3645"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bony alignment decisions affect patient-specific laxity phenotype patterns significantly, independent of the deformity\",\"authors\":\"Heiko Graichen, George M. Avram, Francesco Zambianchi, Niklas M. Graichen, Fabio Catani, Sebastien Lustig, Michael T. Hirschmann\",\"doi\":\"10.1002/ksa.12730\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level III.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17880,\"journal\":{\"name\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"volume\":\"33 10\",\"pages\":\"3637-3645\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12730\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12730","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Bony alignment decisions affect patient-specific laxity phenotype patterns significantly, independent of the deformity
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.
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).
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