Coronal and sagittal alignment of the lower limb in Caucasians: Analysis of a 3D CT database

Vialla, Tristan; Joseph, Etienne; LiArno, Sally; Faizan, Ahmad; Martz, Pierre; Ollivier, Matthieu

doi:10.1016/j.otsr.2022.103251

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Among the 16 relevant studies, eight had a sample size of fewer than 100 cases and were thus excluded. In Caucasian studies, the differences between the Canadian population of Cooke et al 25 and our study population were mainly reflected in smaller mLDFA and mMPTA; the European American population of Siboni et al 36 had smaller mLDFA, mMPTA, and JLCA than those in our study population. The Belgian population of Bellemanns et al 29 differed from our study population in mLDFA, mMPTA, and JLCA, and mLDFA was slightly larger than that of our results, as well as mMPTA and JLCA, which were smaller than that our results.…”

Section: Comparison With Other Studiescontrasting

confidence: 53%

“…Extensive research has been conducted on the coronal morphological parameters of lower limbs in healthy individuals. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Most studies used radiographic data from the longleg anteroposterior radiographs (LLRs); Than et al 30 and Hodel et al 34 used radiographic data from the EOS imaging, and Hirschmann et al 35 and Siboni et al 36 used lower limb computed tomography (CT). Although EOS imaging and CT scans can furnish more precise data due to their lower radiation doses and cost-effectiveness, LLRs remain the preferred choice for large-scale studies.…”

Section: Introductionmentioning

confidence: 99%

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A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non‐knee Osteoarthritis Populations

Jiang,

Xie,

Chen

et al. 2023

Orthopaedic Surgery

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ObjectivesAnalyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non‐KOA populations, employing a substantial sample size.MethodsA cross‐sectional retrospective analysis was performed on the Chinese non‐KOA populations (n = 407; 49.9% females). The study employed an in‐house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip‐knee‐ankle angle (HKAA), weight‐bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral‐proximal‐femoral angle (mLPFA), mechanical lateral‐distal‐femoral angle (mLDFA), mechanical medial‐proximal‐tibial angle (mMPTA), and mechanical lateral‐distal‐tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut‐off point).ResultsHKAA and JLCA exhibited left–right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender‐related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters.ConclusionsThere were differences in lower limb coronal morphological parameters among Chinese non‐KOA populations between left and right sides, different genders, and age.

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Section: Comparison With Other Studiescontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non‐knee Osteoarthritis Populations

Jiang,

Xie,

Chen

et al. 2023

Orthopaedic Surgery

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“…This could be due to differences in axial alignment between 2D and 3D scans, which could affect alignment measurements 30 . It could also be due to a difference in demographic characteristics between the populations in this study and the previous studies, as age, sex, and race and/or ethnicity could influence the mean alignment parameters 31-33 .…”

Section: Discussionmentioning

confidence: 79%

Automatic Assessment of Lower-Limb Alignment from Computed Tomography

Kuiper

Seevinck

Viergever

et al. 2023

Journal of Bone and Joint Surgery

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Background: Preoperative planning of lower-limb realignment surgical procedures necessitates the quantification of alignment parameters by using landmarks placed on medical scans. Conventionally, alignment measurements are performed on 2-dimensional (2D) standing radiographs. To enable fast and accurate 3-dimensional (3D) planning of orthopaedic surgery, automatic calculation of the lower-limb alignment from 3D bone models is required. The goal of this study was to develop, validate, and apply a method that automatically quantifies the parameters defining lower-limb alignment from computed tomographic (CT) scans.Methods: CT scans of the lower extremities of 50 subjects were both manually and automatically segmented. Thirty-two manual landmarks were positioned twice on the bone segmentations to assess intraobserver reliability in a subset of 20 subjects. The landmarks were also positioned automatically using a shape-fitting algorithm. The landmarks were then used to calculate 25 angles describing the lower-limb alignment for all 50 subjects. Results:The mean absolute difference (and standard deviation) between repeat measurements using the manual method was 2.01 ± 1.64 mm for the landmark positions and 1.05°± 1.48°for the landmark angles, whereas the mean absolute difference between the manual and fully automatic methods was 2.17 ± 1.37 mm for the landmark positions and 1.10°± 1.16°for the landmark angles. The manual method required approximately 60 minutes of manual interaction, compared with 12 minutes of computation time for the fully automatic method. The intraclass correlation coefficient showed good to excellent reliability between the manual and automatic assessments for 23 of 25 angles, and the same was true for the intraobserver reliability in the manual method. The mean for the 50 subjects was within the expected range for 18 of the 25 automatically calculated angles. Conclusions:We developed a method that automatically calculated a comprehensive range of 25 measurements that defined lower-limb alignment in considerably less time, and with differences relative to the manual method that were comparable to the differences between repeated manual assessments. This method could thus be used as an efficient alternative to manual assessment of alignment.Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. Surgical correction of a lower-limb malalignment typically consists of an osteotomy in the femur and/or tibia. For surgical planning, the malalignment is quantified using predefined landmarks and angles, such as the center points of the femoral head, knee, and ankle, which define the mechanical hip-knee-ankle (mHKA) angle. Paley 1 described these angles, and the methods to restore the alignment, for almost all types of malalignments.Conventionally, these angles are measured on 2-dimensional (2D) radiographs to define the malalignment in the frontal and sagittal planes. The introduction of 3-dimensional (3D) imaging and planning now enables mor...

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“…Osteotomy planning requires a definition of normality among healthy individuals, with most of the literature on the subject consisting of small series of arthritic patients and some rare studies focusing on what lower-limb alignment "is" within the Caucasian population. In this present issue, Siboni et al [3] exhibited that neutral lower-limb alignment, resulting from a valgus femur and a varus tibia, was the most common morphotype in Caucasian individuals, allowing a "normal" range of bony anatomy to be defined and used in various knee surgery.…”

Section: Meniscusmentioning

confidence: 90%

Recent advances in ligamentous, meniscal and joint-preserving knee surgery: Pushing the limits

Ollivier¹,

Batty²,

Murgier³

et al. 2022

Orthopaedics & Traumatology: Surgery & Research

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Coronal and sagittal alignment of the lower limb in Caucasians: Analysis of a 3D CT database

Cited by 13 publications

References 29 publications

A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non‐knee Osteoarthritis Populations

A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non‐knee Osteoarthritis Populations

Automatic Assessment of Lower-Limb Alignment from Computed Tomography

Recent advances in ligamentous, meniscal and joint-preserving knee surgery: Pushing the limits

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