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Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype.

Methods

A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip–knee–ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.

Results

The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment.

Conclusion

Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus.

Level of clinical evidence

III, retrospective cohort study.

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Abbreviations

HKA:

Hip–knee–ankle angle

LDFA:

Lateral distal femoral angle

MPTA:

Medial proximal tibial angle

PPTA:

Posterior proximal tibial angle

PDFA:

Posterior distal femoral angle

nwJLCA:

Non weight-bearing joint line convergence angle

CT:

Computed tomography

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Funding

No funding was needed for this study.

Author information

Authors and Affiliations

  1. iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d’Azur, Nice, France

    Grégoire Micicoi

  2. Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France

    Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Kristian Kley, Sébastien Parratte & Matthieu Ollivier

  3. Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France

    Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Sébastien Parratte & Matthieu Ollivier

  4. Stryker, Mahwah, NJ, USA

    Sally LiArno & Ahmad Faizan

  5. Adult Reconstructive Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates

    Sébastien Parratte

  6. The London clinic, 20 Devonshire Pl, Marylebone, London, W1G 6BW, UK

    Kristian Kley

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  1. Grégoire Micicoi
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Contributions

MO, KK and SP: designed the protocol and performed statistical analysis; SL and FA: collected the Data; GM: wrote the initial draft and perform edition the different version of the manuscript; MO, KK and SP: corrected the different versions of the draft. All the authors approved the submitted version.

Corresponding author

Correspondence to Matthieu Ollivier.

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Conflict of interest

GM, CJ, AS have nothing to disclose. MO and KK are educational consultant for Stryker, Arthrex and Newclip. FA and SL are paid employee of Stryker. SP is educational consultant and receive royalties from Zimmer Biomet.

Ethical approval

The local ethics committee approved our study protocol prior to investigation (number: 2019-015333-13).

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Micicoi, G., Jacquet, C., Sharma, A. et al. Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database. Knee Surg Sports Traumatol Arthrosc 29, 849–858 (2021). https://doi.org/10.1007/s00167-020-06030-4

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