ArticleBioengineering (Basel, Switzerland)2025
Rotational Projection Errors in Coronal Knee Alignment on Weight-Bearing Whole-Leg Radiographs: A 3D CT Reference Across CPAK Morphotypes.
Article in Bioengineering (Basel, Switzerland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Medial expected gap (mEG): a quantitative, biology-guided predictor of coronal plane correction and knee balance in robotic functionally aligned total knee arthroplasty.Journal of robotic surgery · 2026Article
- Artificial intelligence in knee osteotomy: evolution of alignment assessment and surgical decision-making.Journal of robotic surgery · 2026Review
- Second-knee transfusion burden persists under a high-dose intravenous iron protocol without tranexamic acid in one-week staged bilateral total knee arthroplasty: a paired cohort study.BMC musculoskeletal disorders · 2026Article
- Review
- Deviation from native medial posterior tibial slope and dose-response relationships with forgotten joint score-12 in Robot-assisted versus conventional manual total Knee arthroplasty: A retrospective cohort study.Journal of orthopaedic surgery and research · 2026Article
- Distribution of coronal plane alignment knee phenotypes in Japanese patients with knee osteoarthritis: a comparison of two-dimensional and three-dimensional measurements.Journal of orthopaedics · 2026Article
- Inter- and Intra-Rater Reliability of Pre-Resection Ligament Tension Assessment Using a Digital Tensioner in Imageless Robotic-Assisted Total Knee Replacement.Orthopaedic surgery · 2026Article
- Weight-bearing 3D morphology of valgus knees: A comparative study within a varus dominant cohort.Journal of experimental orthopaedics · 2026Article
- Consistently high accuracy of digital 2D templating in total knee arthroplasty across different levels of surgical training.Arthroplasty (London, England) · 2026Article
- Weight-bearing computed tomography in knee pathologies: current evidence and future perspectives.Frontiers in surgery · 2026Review
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Authors and funding
3 authors.
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Abstract
Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index-the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles-including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip-knee-ankle angle (aHKA°)-were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°,
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