ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Constitutional and postoperative joint line obliquity can predict serial alignment change after opening-wedge high tibial osteotomy: analysis using coronal plane alignment of the knee classification.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Coronal Plane Alignment of the Knee (CPAK) in children and adolescents : an analysis of 655 knees according to the CPAK classification.Bone & joint open · 2026Article
- Modification of the coronal plane alignment of the knee classification considering the joint line convergence angle in high tibial osteotomy: a geometric approach.Journal of orthopaedic surgery and research · 2026Article
- Effect of Coronal Plane Knee Alignment Classification on Clinical Outcomes After High Tibial Osteotomy.Orthopaedic journal of sports medicine · 2026Article
- CPAK phenotypes in medial open wedge high tibial osteotomy: undercorrection as the key factor influencing clinical outcomes and cartilage regeneration.Journal of orthopaedic surgery and research · 2026Article
- High survival rates and patient satisfaction 12 years after medial open wedge high tibial osteotomy surgery: A prospective cohort study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Impact of mechanical axis position and coronal plane alignment phenotypes on clinical outcomes in medial opening wedge high tibial osteotomy.International orthopaedics · 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
- 3D-printed patient-specific instrumentation and the freehand technique in high-tibial osteotomy: A prospective cohort-comparative study in an outpatient setting.Journal of experimental orthopaedics · 2025Article
- The Coronal Plane Alignment of the Knee Classification: How It Works, How to Apply It, and How It can Affect Outcomes in Knee Reconstruction Surgery.JB & JS open accessReview
Corrections and comments
- Erratum issued
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purposes of this study were (1) to clarify the distribution of the Coronal Plane Alignment of the Knee (CPAK) phenotype in patients who underwent medial opening-wedge high tibial osteotomy (OWHTO) and (2) to identify the predictive factors for postoperative serial alignment changes after OWHTO by analyzing constitutional phenotypes.
methodsPatients who underwent OWHTO between March 2014 and December 2019 were retrospectively evaluated. Those who completed a minimum follow-up of 3 years were divided into three groups based on the direction of alignment changes from postoperative 3 months to the final follow-up: Group 1 (varus direction) when the weight-bearing line ratio (WBLR) change was less than - 4%, Group 2 (maintained) when the WBLR change was between - 4% and 4%, and Group 3 (valgus direction) when the WBLR change was greater than 4%. The following parameters were assessed serially and compared between the groups: (1) radiologic parameters of coronal limb alignment such as joint line obliquity (JLO), (2) CPAK phenotypes, and (3) clinical outcomes.
resultsIn total, 163 knees were included, and the average duration of follow-up was 4.8 ± 1.6 years. More apex distal JLO was observed in the order of Group 1, 2, and 3 at all times (all p < 0.05). The most common CPAK type was type (I + II) (constitutional: apex distal JLO) + type (V + VI) (postoperative 3 months: neutral JLO) in Group 1 (29.4%; p = 0.000); otherwise, the most common CPAK type was type (IV + V) (constitutional: neutral JLO) + type (VIII + IX) (postoperative 3 months: apex proximal JLO) in Group 3 (11.7%; p = 0.000). Clinical outcomes did not differ between the groups.
conclusionConstitutional and postoperative JLO were predictive factors of postoperative alignment changes after OWHTO. Constitutional apex distal and postoperative neutral JLO had a tendency for varus alignment progression, whereas constitutional neutral and postoperative apex proximal JLO had a tendency for valgus alignment progression. LEVEL OF EVIDENCE: Retrospective cohort study; Level III.
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