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Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Coronal alignment of the knee is defined by the hip–knee–ankle angle (HKA), the femoral mechanical angle (FMA), the tibial mechanical angle (TMA), and the joint line convergence angle (JLCA). To date, there is still a lack of knowledge about the variability of native coronal knee alignment. The purpose of this paper is to present a systematic review of the current literature about the variability of coronal knee alignment (HKA, FMA, TMA, and JLCA) in non-osteoarthritic knees.

Methods

The electronic databases MEDLINE, EMBASE, and Google Scholar were searched from database inception to search date (November 1, 2018) and screened for relevant studies. The PRISMA guidelines were followed. Inclusion criteria were studies that reported the coronal alignment of the native, non-osteoarthritic knee.

Results

A total of 15 studies met the inclusion criteria. Thirteen studies performed the measurements on weight-bearing long-leg standing radiographs (LLR), one study used MRI, and one study used the EOS imaging system. The mean HKA ranged from 176.7° ± 2.8° (male) to 180.7° (female). The mean FMA ranged from 92.08° ± 1.78° (female) to 97.2° ± 2.7° (female). The mean TMA ranged from 84.6° ± 2.5° (female) to 89.6° (female). The mean JLCA ranged from − 0.47° ± 0.98° (male) to − 1.9° ± 1.4° (female).

Conclusion

This systematic review provides a detailed overview about the variability of the coronal knee alignment in non-osteoarthritic knees. The broad variability of all coronal alignment parameters highlights the necessity for a more anatomic and individualized approach in knee arthroplasty. It also offers the fundament to understand the changes in osteoarthritic knees.

Level of clinical evidence

Systematic review, Level IV.

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Abbreviations

HKA:

Hip–knee–ankle angle

FMA:

Femoral mechanical angle

TMA:

Tibial mechanical angle

JLCA:

Joint line convergence angle

LLR:

Long-leg radiographs

MRI:

Magnet resonance imaging

CT:

Computed tomography

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Funding

There was no financial conflict of interest with regards to this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Lukas B. Moser, Silvan Hess & Michael T. Hirschmann

  2. University of Basel, Basel, Switzerland

    Lukas B. Moser & Michael T. Hirschmann

  3. University of Bern, Bern, Switzerland

    Silvan Hess

  4. Amsler Consulting, Basel, Switzerland

    Felix Amsler

  5. Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Henrik Behrend

Authors
  1. Lukas B. Moser
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  2. Silvan Hess
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  3. Felix Amsler
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  4. Henrik Behrend
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  5. Michael T. Hirschmann
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Contributions

LBM participated in study design, literature review, data collection, figures and tables, and manuscript writing. SH participated in literature review, data collection, and manuscript editing. FA participated in study design and manuscript editing. HB participated in study design and manuscript editing. MTH participated in study design and manuscript editing. All authors read and approved the final manuscript.

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Correspondence to Lukas B. Moser.

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Ethical approval was not required as this is a pure review of the literature not involving humans nor animals.

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Moser, L.B., Hess, S., Amsler, F. et al. Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc 27, 1359–1367 (2019). https://doi.org/10.1007/s00167-019-05417-2

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  • DOI: https://doi.org/10.1007/s00167-019-05417-2

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