Kim Sung Eun, MacDessi Samuel, Song Daeseok, Kim Joong Il, Choi Byung Sun, Han Hyuk-Soo, Ro Du Hyun
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Bone Joint Surg Am. 2024 Dec 24;107(3):297-303. doi: 10.2106/JBJS.24.00316.
Studies investigating constitutional alignment across various grades of osteoarthritis (OA) are limited. This study explored the distribution of Coronal Plane Alignment of the Knee (CPAK) types and associated radiographic parameters with increasing OA severity.
In this retrospective cross-sectional study, 17,365 knees were analyzed using deep learning software for radiographic measurements. Knees were categorized on the basis of the Kellgren and Lawrence (KL) grade and CPAK type. Radiographic measurements were the hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), arithmetic HKAA (aHKA), joint line obliquity (JLO), and joint line convergence angle (JLCA). Age-stratified analysis was performed to differentiate the impact of age on OA severity.
A shift in the most common CPAK type from II to I was found with increasing KL grade (p < 0.05). Furthermore, there was a corresponding increase in LDFA and JLCA with increasing KL grade, while HKAA, MPTA, and aHKA decreased after KL grade 2. Age exhibited limited association with LDFA and MPTA, suggesting that OA severity is the dominant factor related to the CPAK distribution.
The study found a shift in CPAK type with worsening OA. It is possible that constitutional varus types are more susceptible to OA, or that their increased OA prevalence is related to anatomical changes. This analysis offers new insights into alterations in CPAK type that occur with OA and underscores the importance of understanding pre-arthritic anatomy when performing joint reconstruction.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
关于不同程度骨关节炎（OA）患者骨骼排列情况的研究有限。本研究探讨了随着骨关节炎严重程度增加，膝关节冠状面排列（CPAK）类型的分布以及相关的影像学参数。
在这项回顾性横断面研究中，使用深度学习软件对17365个膝关节进行影像学测量分析。根据Kellgren-Lawrence（KL）分级和CPAK类型对膝关节进行分类。影像学测量指标包括髋-膝-踝角（HKAA）、股骨远端外侧角（LDFA）、胫骨近端内侧角（MPTA）、算术髋-膝角（aHKA）、关节线倾斜度（JLO）和关节线汇聚角（JLCA）。进行年龄分层分析以区分年龄对骨关节炎严重程度的影响。
随着KL分级增加，最常见的CPAK类型从II型转变为I型（p < 0.05）。此外，随着KL分级增加，LDFA和JLCA相应增加，而HKAA、MPTA和aHKA在KL 2级后下降。年龄与LDFA和MPTA的关联有限，表明骨关节炎严重程度是与CPAK分布相关的主要因素。
本研究发现随着骨关节炎病情加重，CPAK类型发生改变。可能骨骼内翻类型更容易患骨关节炎，或者其骨关节炎患病率增加与解剖结构变化有关。该分析为骨关节炎患者CPAK类型的改变提供了新见解，并强调了在进行关节重建时了解关节炎前解剖结构的重要性。
预后性III级。有关证据水平的完整描述，请参阅作者指南。
