ArticleArchives of orthopaedic and trauma surgery2026
Standardizing Joint-Line determination on anteroposterior knee radiographs: multicenter validation of the adductor ratio and a novel composite index in 3000 knees.
Article in Archives of orthopaedic and trauma surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo quantify how sex, age, and region affect radiographic joint-line (JL) measurements and indices on standardized anteroposterior knee radiographs across ten countries, and to identify a demography-resistant metric set for reliable JL restoration.
methodsMulticenter retrospective study of 3,000 AP knee radiographs obtained from ten countries. Standardized acquisition (SID 100 cm; AP, full extension, no rotation). Exclusions: prior peri-knee fracture/surgery, KL 3–4 OA, neurovascular deficit, septic arthritis, rheumatologic disease, BMI > 30, inadequate AP. Measurements: ATJL, FHJL, MEJL, LEJL, FW. Derived indices: literature-based ATJL/FW, FHJL/FW, MEJL/FW, LEJL/FW, JL1, JL2; newly defined JL-AF, JL-Combine, JL-Symmetry, JL-Ratio, JL3. Statistics: t-tests, one-/two-way ANOVA, multiple regression; effect sizes (Cohen’s d, η2); variability (CoV). α = 0. 05.
resultsMen showed higher FW (92. 83 ± 11. 15 vs 81. 38 ± 8. 54), ATJL (52. 16 ± 6. 31 vs 46. 07 ± 5. 46), FHJL (20. 74 ± 4. 05 vs 19. 13 ± 4. 04), MEJL (38. 22 ± 8. 96 vs 34. 62 ± 7. 67), and LEJL (35. 35 ± 8. 90 vs 32. 07 ± 7. 64); all p < 0. 001. With aging, FHJL, MEJL, and LEJL decreased (p < 0. 001); FW and ATJL showed no relevant age effect (p > 0. 05). Region strongly impacted all variables (largest η2: LEJL 0. 583, MEJL 0. 561, FW 0. 493). Among derived metrics, ATJL/FW (η2 = 0. 016, CoV = 0. 228) and JL3 (η2 = 0. 023, CoV = 0. 235) were the most stable across demographics. JL-AF (η2 = 0. 036), JL-Combine (0. 028), and JL-Symmetry (0. 028) were low-dependency validators. FW-based JL1 (η2 = 0. 899) and JL2 (0. 702) were demography-sensitive and unreliable as stand-alone predictors.
conclusionBasic anatomic distances are demography-dependent and poor single guides for JL restoration. A normalize-and-combine strategy—using ATJL/FW as the anchor and JL3 as the composite confirmatory index (optionally cross-checked by JL-AF/JL-Combine/JL-Symmetry)—provides robust, transferable radiographic estimation across centers. Avoid single-variable FW models (e. g., JL1) in routine planning. Larger, population-level datasets should support personalized thresholds.
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