Weight-bearing 3D morphology of valgus knees: A comparative study within a varus dominant cohort.

Purpose: Using a weight-bearing 3D assessment method to characterize the skeletal morphology and lower-limb alignment of valgus knees, using a larger cohort of varus knees as a reference. Methods: We retrospectively reviewed imaging data of Knee osteoarthritis (KOA) patients (2010-2025), including 60 valgus and 264 varus knees classified by the coronal hip-knee-ankle (HKA). CT-based 3D bone models were registered to biplanar weight-bearing radiographs to quantify femoral and tibial morphological parameters and lower-limb alignment under weight-bearing conditions. Results: Compared with varus knees, valgus knees had greater femoral neck anteversion and larger condylar twist angle (both Conclusion: This study uses weight-bearing 3D assessment technology to investigate valgus knees within a dataset dominated by varus knees, comparing differences in skeletal morphology and lower-limb alignment between varus and valgus knees. These results indicate that, compared with varus knees, valgus knees exhibit demonstrate skeletal morphology and lower-limb alignment across multiple planes. These findings provide new evidence supporting multiplanar differences in the phenotypic characterization of knee osteoarthritis. Level of Evidence: Level III.