ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
The importance of joint line obliquity: a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 35 citations in OpenAlex.
- Kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review and meta-analysis of medium to long-term outcomes.Musculoskeletal surgery · 2026Review
- Predictive pre-resection robotic ligament balancing in total knee arthroplasty is accurate across surgeons and patient factors.Journal of robotic surgery · 2026Article
- Robotic-assisted total knee arthroplasty reduces alignment variability and rotational outliers compared with conventional techniques.International orthopaedics · 2026Article
- Impact of changes in native coronal plane alignment of the knee (CPAK) on patient-reported outcome measures (PROMS). A bilateral single implant study.Journal of orthopaedics · 2025Article
- Early radiological outcomes of imageless robotic-assisted total knee arthroplasty with VELYS: a comparative study of CPAK varus vs. valgus phenotypes.Journal of robotic surgery · 2025Article
- Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Distribution of coronal plane alignment of the knee and functional knee phenotype classification in the Thai arthritic population and correlation with other Asian populations.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Excellent results of restricted kinematic alignment total knee arthroplasty at a minimum of 10 years of follow-up.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Cartilage thickness can be accurately measured intraoperatively in total knee arthroplasty: A step further in calipered kinematic alignment.Journal of experimental orthopaedics · 2025Article
- Better restoration of joint line obliquity in tibia first restricted kinematic alignment versus mechanical alignment TKA.Archives of orthopaedic and trauma surgery · 2024Article
- Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Functional alignment in total knee arthroplasty best achieves balanced gaps and minimal bone resections: an analysis comparing mechanical, kinematic and functional alignment strategies.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Laxity, Balance, and Alignment of a Simulated Kinematic Alignment Total Knee Arthroplasty.Arthroplasty today · 2023Article
- Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Restricted Inverse Kinematic Alignment Better Restores the Native Joint Line Orientation While Achieving Similar Balance, Laxity, and Arithmetic Hip-Knee-Ankle Angle to Gap Balancing Total Knee Arthroplasty.Arthroplasty today · 2023Article
- Kinematic Alignment of Failed Mechanically Aligned Total Knee Arthroplasty Restored Constitutional Limb Alignment and Improved Clinical Outcomes: A Case Report of 7 Patients.Journal of personalized medicine · 2022Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeRestricted kinematic alignment (rKA) in total knee arthroplasty (TKA) aims to restore native soft tissue laxities while limiting alignment extremes that risk prosthetic failure. However, there is no consensus where restricted boundaries (RB) should be set. This study aims to determine the proportion of limbs in which constitutional alignment and joint line obliquity (JLO) would be restored with various RB scenarios, to inform decision making in rKA TKA.
methodsThe mechanical hip-knee-ankle (mHKA) angle, arithmetic hip-knee-ankle (aHKA) angle, lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured on radiographs of 500 normal knees. Incrementally wider RBs were then applied. The proportion of limbs within each increment was determined when RBs were applied only to HKA, or to HKA, LDFA and MPTA together. In addition, the proportion of limbs within published adjusted mechanical alignment (aMA) and rKA protocols were determined, as well as those within one, two and three standard deviations of the means for HKA, LDFA and MPTA.
resultsWhen restrictions to mHKA alone were applied, 74.0% and 97.8% of knees were captured with boundaries of ± 3° and ± 6° respectively. However, when the same boundaries to HKA were also applied to MPTA and LDFA, 36.2% and 91.0% of knees were captured respectively, highlighting the limiting effect that JLO has on restoration of normal knee phenotypes. When comparing previously published boundaries, aMA of 0° ± 3° captured 36.2%; rKA of 0° ± 3 for HKA and 85° to 95° for LDFA/MPTA captured 67.8%; rKA of - 5° to 4° HKA and 86°-93° for LDFA/MPTA captured 63%; and rKA of - 6° to + 3° for HKA and 84°-93° for LDFA/MPTA captured 85.4%.
conclusionThe greatest proportions of normal knee phenotypes were captured with boundaries that were centred around population means for HKA and JLO. Further, these findings demonstrate that restricting the JLO has a significant limiting influence on restoration of normal knee phenotypes beyond that of restricting HKA alone. LEVEL OF EVIDENCE: III.
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