Department of Orthopaedic Surgery and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Bruges, Belgium.
Department of Orthopaedic Surgery and Traumatology, Sint-Lucas Hospital, Sint-Lucaslaan 29, 8310, Bruges, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):477-487. doi: 10.1007/s00167-020-06152-9. Epub 2020 Jul 21.
Implementation of morphometric reference data from the contralateral, unaffected lower limb is suggested when reconstructing the coronal plane alignment in TKA. Limited information, however, is available which confirms this left-to-right symmetry in coronal alignment based upon radiographs. The purpose of the study was, therefore, (1) to verify if a left-to-right symmetry is present and (2) to assess whether the contralateral lower limb would be a reliable reference for reconstructing the frontal plane alignment.
Full-leg standing radiographs of 250 volunteers (male, 125; female,125) were reviewed for three alignment parameters (Hip-Knee-Ankle angle (HKA), Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA)). Evaluation of assumed left-to-right symmetry was performed according to two coronal alignment classifications (HKA subdivisions (HKA) and limb, femoral and tibial phenotypes (HKA, FMA and TMA)). Inter- and within-subject variability was calculated, along with correlations coefficients (r) and coefficients of determination (r). Reliability of the contralateral limb as a personalized reference to reconstruct the constitutional alignment was investigated by intervals, expanding by 1° increments (0.5° increment both to varus and valgus) around the right knee alignment parameters. Subsequently, it was verified whether or not the left knee parameters fell within this interval.
Symmetrical distribution in coronal alignment was found in 79% (HKA subdivision) and 59% (limb phenotype) of the cohort. Gender differences were present for the most common symmetric limb phenotypes (VAR3° (23.2%) in males and NEU0° (38.4%) in females). Inter-subject variability was more prominent than the within-subject side differences for all parameters. Correlations analyses revealed mostly moderate correlations between the alignment measurements. Coefficients of determination showed overall weak left-to-right relationship, except for a moderate predictability for HKA (r = 0.538, p < 0.001) and FMA (r = 0.618, p < 0.001) in females. FMA and TMA marked weak predictive values for contralateral HKA. Only 60% of left knees were referenced within a 3° interval around the right knee.
No strict left-to-right symmetry was observed in coronal alignment measurements. There is insufficient left-to-right agreement to consider the concept of the contralateral unaffected limb as an idealized reference for frontal plane alignment reconstruction based upon full-leg standing radiographs.
I.
在 TKA 中重建冠状面对线时，建议使用对侧未受影响的下肢的形态计量参考数据。然而，基于 X 线片确认这种冠状对线左右对称性的信息有限。因此，本研究的目的是：(1)验证是否存在左右对称性；(2)评估对侧下肢是否可作为重建额状面对线的可靠参考。
对 250 名志愿者（男性 125 名，女性 125 名）的全长站立位 X 线片进行了 3 项对线参数（髋膝踝角（HKA）、股骨机械角（FMA）和胫骨机械角（TMA））的评估。根据两种冠状对线分类（HKA 细分（HKA）和肢体、股骨和胫骨表型（HKA、FMA 和 TMA））评估假定的左右对称性。计算了组内和组间的变异性，以及相关系数（r）和决定系数（r）。通过围绕右膝对线参数以 1°增量（向内外侧各增加 0.5°）扩展的区间来研究对侧肢体作为重建个体固有对线的参考的可靠性。随后，检查左膝参数是否在此区间内。
79%（HKA 细分）和 59%（肢体表型）的队列存在冠状对线的对称分布。最常见的对称肢体表型在性别上存在差异（男性 VAR3°（23.2%），女性 NEU0°（38.4%））。对于所有参数，组间变异性大于组内侧间差异。相关性分析显示，对线测量之间的相关性大多为中度。决定系数总体上显示出较弱的左右关系，但女性的 HKA（r=0.538，p<0.001）和 FMA（r=0.618，p<0.001）具有中度可预测性。FMA 和 TMA 对 HKA 有较弱的预测值。只有 60%的左膝在右膝 3°的区间内被引用。
冠状对线测量未观察到严格的左右对称性。左右对称性不足，不足以将对侧未受影响的肢体作为基于全长站立位 X 线片重建额状面对线的理想参考。
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