Assessment of joint line obliquity and its related frontal deformity using long-standing radiographs

Xie, Tianshun; Veen, Hugo C. van der; Akker‐Scheek, Inge van den; Brouwer, Reinoud W

doi:10.1016/j.jor.2023.04.014

Cited by 9 publications

(11 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The radiographic measurements were completed by two fellowship-trained orthopaedic specialists. Measurements were carried out twice with an interval of 8 weeks in between; the following parameters were measured: hip knee ankle (HKA) [15], weightbearing line ratio (WBR) [8], medial proximal tibial angle (MPTA) [22], mLDFA [22], KJLO [22], joint line convergence angle (JLCA) [12], knee-ankle joint angle (KAJA) [28,30], and distal tibial ground surface angle (DTGSA) [22]. (Figures 1-3, respectively).…”

Section: Radiological Analysismentioning

confidence: 99%

“…A positive value indicates that the lateral tibial articular surface is higher than the medial one and the angle is lateral oblique [22]. Xie et al defined this line as the joint line orientation angle by the tibial plateau (JLOAT) [30].…”

Section: Kjlomentioning

confidence: 99%

“…In the KJLO measurement technique, the cut-off value for the apex position was determined as 2° [22,30]. The medial side was determined as the apex of the joint.…”

Section: Kjlomentioning

confidence: 99%

“…The ideal value for the orientation of the knee joint line is considered to be the tibial plateau in a fully parallel, 0°position relative to the ground [31]. Currently, various measurement techniques have been described regarding the inclination of the knee joint line [30]. However, there are few studies that have evaluated the long-term clinical implications of these techniques [16,28,30].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, various measurement techniques have been described regarding the inclination of the knee joint line [30]. However, there are few studies that have evaluated the long-term clinical implications of these techniques [16,28,30]. The knee joint line orientation angle (KJLOA), also known as knee joint line obliquity (KJLO), demonstrates the position of the proximal tibial plateau relative to the ground.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

CPAK classification detect the real knee joint apex position in less than half of the knees

Şahbat,

Chou,

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeAccurate assessment of the knee joint line is essential for surgeries involving the knee. The knee joint line obliquity (KJLO) is a radiological measurement that evaluates the position of the knee joint relative to the ground and is frequently used in preoperative planning and clinical follow‐up. On the other hand, coronal plane alignment of the knee (CPAK) classifications assesses the joint line as the summation of the medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The purpose of this study is to determine the concordance of these two measurement techniques.MethodsThis cross‐sectional study evaluated the long‐leg standing radiographs (LSRs) of 164 healthy knees. The extremity KJLO and CPAK classification JLO were measured twice by two observers at 8‐week intervals. The knee joint line apex positions (proximal, neutral and distal) of the two measurement techniques are compared (concordance or discordant). The intraobserver and interobserver reliability were examined using the intraclass correlation coefficient (ICC). Possible causes of the discordant were evaluated with univariate and multivariate logistic regression analysis.ResultsCPAK classification detected the KJLO apex position in 70 extremities (42.7%) only. Subgroups CPAK JLO detected 13.6% of the proximal apex, 20.4% of the neutral, and 90.7% of the distal apex (p < 0.01). Upon multivariate logistic regression analysis, the variable KJLO apex position (proximal, neutral vs. distal, odds ratio (OR) = 10.291, 95% confidence interval [CI] = 2.225–25.656, and (p < 0.01) was determined as a risk factor for discordant.ConclusionThe CPAK JLO measurement technique can be misleading in defining the KJLO apex position and the concordance between them is less than 50%. It has a high tendency to misleadingly predict proximal and neutral apex positions, which can potentially have negative implications for assessing the joint line.Level of EvidenceLevel I.

show abstract

Section: Radiological Analysismentioning

confidence: 99%

Section: Kjlomentioning

confidence: 99%

“…In the KJLO measurement technique, the cut-off value for the apex position was determined as 2° [22,30]. The medial side was determined as the apex of the joint.…”

Section: Kjlomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

CPAK classification detect the real knee joint apex position in less than half of the knees

Şahbat,

Chou,

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

show abstract

Letter to the Editor on: ‘CPAK classification detect the real knee joint apex position in less than half of the knees’

Pujol,

Leal‐Blanquet

2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Answer to the letter concerning the work: CPAK classification detects the real knee joint apex position in less than half of the knees

Şahbat,

Chou,

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

We read with great interest the letter to the editor on about our latest article: 'CPAK classification detects the real knee joint apex position in less than half of the knees' [8]. First, we thank the authors for summarizing the article with the first paragraph and emphasizing its importance on the philosophy of lower extremity alignment. However, we must make it clear again that our study examines the radiological concordance or discordance of the measurement technique, not its clinical superiority.The authors of the letter describe the Knee Joint Line Obliquity (KJLO) [11] and Coronal Plane Alignment of the Knee Joint Line Obliquity (CPAK JLO) measurements [5] in the second paragraph, but this information and the discordance between them are analysed in detail in the methods and discussion sections of our study. As it is already well known that the CPAK classification does not evaluate soft tissues and is affected by parameters such as gender, degree of arthrosis and racial variation [1, 2, 4, 9], we do not feel that the authors have introduced a new topic.The authors refer to the KJLO measurement analysis in Paragraph 3. Thank you for proposing the additional measurement of joint-line obliquity (JLO). This is a reasonable expectation, but as people walk with their legs shoulder-width apart, this is the measurement technique that should be taken. The JLO can indeed vary depending on the radiological technique employed, such as single-leg standing radiographs, double-leg standing radiographs, and even computed tomography (CT) scans [3,10,11]. To maintain consistency, some authors recommend using the Mikulicz line together with the medial proximal tibial angle (MPTA) and the kneeankle joint angle (KAJA) to accurately determine the actual JLO [7]. However, it remains unclear which measurement method is the most reliable for determining JLO. Furthermore, as noted in our study's limitations, even slight variations in long-leg standing radiographs can affect the measurements.

show abstract

Assessment of joint line obliquity and its related frontal deformity using long-standing radiographs

Cited by 9 publications

References 26 publications

CPAK classification detect the real knee joint apex position in less than half of the knees

CPAK classification detect the real knee joint apex position in less than half of the knees

Letter to the Editor on: ‘CPAK classification detect the real knee joint apex position in less than half of the knees’

Answer to the letter concerning the work: CPAK classification detects the real knee joint apex position in less than half of the knees

Contact Info

Product

Resources

About