Ishaan Jagota, Rami M. A. Al-Dirini, Mark Taylor, Joshua Twiggs, Brad Miles, David Liu
{"title":"膝关节分类系统的冠状面排列不能可靠地预测接受全膝关节置换术的关节炎膝关节的胫股关节间隙。","authors":"Ishaan Jagota, Rami M. A. Al-Dirini, Mark Taylor, Joshua Twiggs, Brad Miles, David Liu","doi":"10.1002/ksa.12734","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Achieving optimal mediolateral balance in extension and flexion is critical for improving outcomes in total knee arthroplasty (TKA). Knee classification tools, like coronal plane alignment of the knee (CPAK), do not directly consider the soft tissue profile of the joint. This study evaluated the variation in tibiofemoral gap measurements across CPAK phenotypes and examined the relationships between preoperative tibiofemoral joint gaps and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO), important for TKA planning and execution.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective analysis of 433 knees from the Joint Dynamics Registry computed tomography (CT) database was performed. Patients received preoperative long-leg CT scans and extension and flexion distracted radiographs. The CT scans were segmented and landmarked to produce three-dimensional bone models and derive anatomical measurements, including aHKA and JLO. The models were registered to the two distracted radiographs, and an osteophyte correction algorithm was applied to calculate the medial and lateral joint gaps in extension and flexion. Composite gap measurements (mean and difference) were also determined. Pearson's correlation and multivariate regression assessed the relationships between joint gaps and aHKA and JLO. ANOVA compared joint gaps across CPAK groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Small but statistically significant differences in joint gap measurements were observed between CPAK groups I and III, and II and III. Weak univariate correlations were observed between aHKA and joint gaps (<i>r</i> ≤ |0.32 |), with fewer statistically significant relationships for JLO (<i>r</i> ≤ |0.15 |). Multivariate regression explained only 10.2% and 1.4% of aHKA and JLO variance, respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>While useful for describing coronal alignment, CPAK displayed limited predictive capability for preoperative tibiofemoral joint gaps in TKA patients. Direct assessment of joint gaps remains crucial for surgical planning. Future research should focus on integrating joint gap measurements with bony morphology in preoperative planning workflows to improve TKA personalisation.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level II.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3675-3685"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12734","citationCount":"0","resultStr":"{\"title\":\"Coronal plane alignment of the knee classification system does not reliably predict tibiofemoral joint gaps in arthritic knees undergoing total knee arthroplasty\",\"authors\":\"Ishaan Jagota, Rami M. A. Al-Dirini, Mark Taylor, Joshua Twiggs, Brad Miles, David Liu\",\"doi\":\"10.1002/ksa.12734\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>Achieving optimal mediolateral balance in extension and flexion is critical for improving outcomes in total knee arthroplasty (TKA). Knee classification tools, like coronal plane alignment of the knee (CPAK), do not directly consider the soft tissue profile of the joint. This study evaluated the variation in tibiofemoral gap measurements across CPAK phenotypes and examined the relationships between preoperative tibiofemoral joint gaps and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO), important for TKA planning and execution.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A retrospective analysis of 433 knees from the Joint Dynamics Registry computed tomography (CT) database was performed. Patients received preoperative long-leg CT scans and extension and flexion distracted radiographs. The CT scans were segmented and landmarked to produce three-dimensional bone models and derive anatomical measurements, including aHKA and JLO. The models were registered to the two distracted radiographs, and an osteophyte correction algorithm was applied to calculate the medial and lateral joint gaps in extension and flexion. Composite gap measurements (mean and difference) were also determined. Pearson's correlation and multivariate regression assessed the relationships between joint gaps and aHKA and JLO. ANOVA compared joint gaps across CPAK groups.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Small but statistically significant differences in joint gap measurements were observed between CPAK groups I and III, and II and III. Weak univariate correlations were observed between aHKA and joint gaps (<i>r</i> ≤ |0.32 |), with fewer statistically significant relationships for JLO (<i>r</i> ≤ |0.15 |). Multivariate regression explained only 10.2% and 1.4% of aHKA and JLO variance, respectively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>While useful for describing coronal alignment, CPAK displayed limited predictive capability for preoperative tibiofemoral joint gaps in TKA patients. Direct assessment of joint gaps remains crucial for surgical planning. 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Coronal plane alignment of the knee classification system does not reliably predict tibiofemoral joint gaps in arthritic knees undergoing total knee arthroplasty
Purpose
Achieving optimal mediolateral balance in extension and flexion is critical for improving outcomes in total knee arthroplasty (TKA). Knee classification tools, like coronal plane alignment of the knee (CPAK), do not directly consider the soft tissue profile of the joint. This study evaluated the variation in tibiofemoral gap measurements across CPAK phenotypes and examined the relationships between preoperative tibiofemoral joint gaps and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO), important for TKA planning and execution.
Methods
A retrospective analysis of 433 knees from the Joint Dynamics Registry computed tomography (CT) database was performed. Patients received preoperative long-leg CT scans and extension and flexion distracted radiographs. The CT scans were segmented and landmarked to produce three-dimensional bone models and derive anatomical measurements, including aHKA and JLO. The models were registered to the two distracted radiographs, and an osteophyte correction algorithm was applied to calculate the medial and lateral joint gaps in extension and flexion. Composite gap measurements (mean and difference) were also determined. Pearson's correlation and multivariate regression assessed the relationships between joint gaps and aHKA and JLO. ANOVA compared joint gaps across CPAK groups.
Results
Small but statistically significant differences in joint gap measurements were observed between CPAK groups I and III, and II and III. Weak univariate correlations were observed between aHKA and joint gaps (r ≤ |0.32 |), with fewer statistically significant relationships for JLO (r ≤ |0.15 |). Multivariate regression explained only 10.2% and 1.4% of aHKA and JLO variance, respectively.
Conclusion
While useful for describing coronal alignment, CPAK displayed limited predictive capability for preoperative tibiofemoral joint gaps in TKA patients. Direct assessment of joint gaps remains crucial for surgical planning. Future research should focus on integrating joint gap measurements with bony morphology in preoperative planning workflows to improve TKA personalisation.
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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