ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
Rotation or flexion alters mechanical leg axis measurements comparably in patients with different coronal alignment.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- High variability exists in 3D leg alignment analysis, but underlying principles that might lead to agreement on a universal framework could be identified: A systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Pooled it
- Influence of axial limb rotation on radiographic lower limb alignment: a systematic review.Archives of orthopaedic and trauma surgery · 2022Pooled it
- Does the preoperative CPAK classification influence clinical outcomes after medial and lateral unicompartmental knee arthroplasty? Short-term outcomes and phenotype distribution in a retrospective series of consecutive cases.Archives of orthopaedic and trauma surgery · 2026Article
- Correlation of Plain Radiographs and 3-Dimensional CT With Coronal and Sagittal Measurements in Patients Undergoing Corrective Osteotomies.Orthopaedic journal of sports medicine · 2026Article
- Significant changes of the mechanical medial proximal tibial angle in dependence of internal and external rotation of the hinge axis in slope correcting infratuberositary tibial deflexion osteotomy.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Rotational Projection Errors in Coronal Knee Alignment on Weight-Bearing Whole-Leg Radiographs: A 3D CT Reference Across CPAK Morphotypes.Bioengineering (Basel, Switzerland) · 2025Article
- Appropriate patient selection based on joint line convergence angle minimizes the difference between the mechanical axis in the standing and supine positions after open-wedge high tibial osteotomy and distal tuberosity osteotomy.Journal of orthopaedic surgery and research · 2025Article
- Influence of different standing positions on anatomical parameters of coronal whole-leg weight-bearing radiographs in preoperative planning for high tibial osteotomy.Journal of experimental orthopaedics · 2024Article
- The coronal alignment differs between two-dimensional weight-bearing and three-dimensional nonweight bearing planning in total knee arthroplasty.Journal of experimental orthopaedics · 2024Article
- Linear correlation between patellar positioning and rotation of the lower limb in radiographic imaging: a 3D simulation study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- [Osteotomies around the knee: preoperative planning using CT-based three-dimensional analysis, patient-specific cutting and reduction guides].Operative Orthopadie und Traumatologie · 2023Review
- Osteotomies around the knee are not correlated to substantial post-operative ankle pain.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Significant changes in lower limb alignment due to flexion and rotation-a systematic 3D simulation of radiographic measurements.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs.Diagnostics (Basel, Switzerland) · 2022Article
- Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography.Clinics in orthopedic surgery · 2022Article
- Anatomical Components Associated With Increased Tibial Tuberosity-Trochlear Groove Distance.Orthopaedic journal of sports medicine · 2022Article
- Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- Effect of limb rotation on radiographic alignment measurement in mal-aligned knees.Biomedical engineering online · 2021Article
- The EOS 3D imaging system reliably measures posterior tibial slope.Journal of orthopaedic surgery and research · 2021Article
- Mal-angulation of femoral rotational osteotomies causes more postoperative sagittal mechanical leg axis deviation in supracondylar than in subtrochanteric procedures.Journal of experimental orthopaedics · 2020Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeFlexion and rotation of the knee joint are supposed to alter the measurement of the mechanical leg axis on long leg radiographs. However, in patients with varus or valgus alignment it has not been systematically analyzed so far. The hypothesis is that measurement of the mechanical leg axis is more influenced by flexion and rotation in presence of varus or valgus alignment compared to patients with a straight coronal alignment.
methods3D surface models of the lower extremities of seven individuals with varying degrees of coronal alignment were created based on CT data. The coronal alignment of the seven individuals captured the range between 9° varus and 9° valgus with equal steps of 3°. Combinations of internal and external rotations of 10°, 20°, and 30° with flexion of 5°, 10°, 15°, 20°, and 30° were simulated. The mechanical leg axis was measured for each combination as the antero-posterior (ap)-projected hip-knee-ankle (HKA-) angle.
results294 simulations with all combinations of rotation and flexion were performed. Ranges of deviation of HKA never showed a critical deviation of more than 3° from median values. Deviations from baseline appeared normally distributed for all flexion and rotation combinations (p < 0.05) and the probability for a deviation from the mean mechanical leg axis of more than 3° was less than 0.03 for all combinations. Comparability of the models, therefore, could be assumed.
conclusionDeviations in HKA-angle measurements, caused by rotation or flexion, does not vary relevantly through the range of coronal alignment of 9° varus to 9° valgus. As a clinical relevance, deviations in HKA-angle measurements can be considered as comparable in patients with different coronal alignment. LEVEL OF EVIDENCE: III.
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