数据胜于教条——外翻膝与外侧股骨髁发育不全无关：来自一家大型机构的基于CT的分析
Data beats dogma-Valgus knees are not associated with a hypoplastic lateral femoral condyle: A CT-based analysis from a high-volume institution.
作者信息
Mancino Fabio, Twiggs Joshua G, Jagota Ishaan, Fritsch Brett A
机构信息
Sydney Orthopaedic Research Institute (SORI), The Knee Institute, St. Leonards, New South Wales, Australia.
Enovis the Company-Enovis, Austin, Texas, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3240-3249. doi: 10.1002/ksa.12688. Epub 2025 May 7.
PURPOSE
Observations following the mechanical alignment principle have led to the concept that the lateral femoral condyle (LFC) is hypoplastic in valgus knee. This study aimed to investigate if this assumption is correct-the hypothesis was that there is no relationship between the radius of curvature of the LFC and coronal alignment.
METHODS
This is a retrospective study of prospectively collected patients who underwent primary robotic TKA between 2021 and 2023. Segmentation of the preoperative computerised tomography scan was performed to obtain a three-dimensional model of the knee. A semi-automated algorithm was used to create a circle of best fit to obtain the radius of each femoral condyle. The size of the condyles was expressed as the lateral-to-medial (L2M) condylar radii ratio. Patients were stratified based on hip-knee-ankle (HKA) angle and L2M ratio, and the association with the alignment was analysed. Distal and posterior offset were investigated and analysed. Significance was for p values < 0.05.
RESULTS
Overall, 498 consecutive knees were investigated. The mean HKA was 4.1 ± 5.4° varus. The mean L2M condylar ratio was 0.95 in patients with neutral alignment, 0.98 in varus alignment and 0.96 in valgus alignment. The L2M ratio was <1 in all alignment groups, with no significant differences between varus and valgus. The knees with a hypoplastic LFC (L2M ratio <0.9) showed a similar HKA distribution to those with L2M > 0.9. No differences in posterior offset of the LFC were noted between valgus, neutral and varus knees. The lateral distal offset was greater in valgus than neutral knees (27.1 ± 2.7 mm vs. 25.9 ± 2.9 mm).
CONCLUSION
The LFC is on average smaller than the MFC regardless of the coronal alignment, with no correlation with the HKA. These findings add evidence against the concept of a hypoplastic LFC in valgus knees.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
目的
遵循机械对线原则的观察结果引出了一个概念，即外翻膝中外侧股骨髁（LFC）发育不全。本研究旨在调查这一假设是否正确——假设是LFC的曲率半径与冠状面排列之间没有关系。
方法
这是一项对2021年至2023年间接受初次机器人全膝关节置换术的前瞻性收集患者的回顾性研究。对术前计算机断层扫描进行分割以获得膝关节的三维模型。使用半自动算法创建最佳拟合圆以获得每个股骨髁的半径。髁的大小用外侧与内侧（L2M）髁半径比表示。根据髋-膝-踝（HKA）角和L2M比将患者分层，并分析其与排列的相关性。对远端和后偏移进行了研究和分析。显著性为p值<0.05。
结果
总体而言，共研究了498例连续的膝关节。平均HKA为内翻4.1±5.4°。中立位排列患者的平均L2M髁比为0.95，内翻位排列患者为0.98，外翻位排列患者为0.96。所有排列组的L2M比均<1，内翻和外翻之间无显著差异。LFC发育不全（L2M比<0.9）的膝关节与L2M>0.9的膝关节显示出相似的HKA分布。外翻、中立和内翻膝关节之间未观察到LFC后偏移的差异。外翻膝关节的外侧远端偏移大于中立膝关节（27.1±2.7mm对25.9±2.9mm）。
结论
无论冠状面排列如何，LFC平均小于内侧股骨髁（MFC），且与HKA无相关性。这些发现为反对外翻膝中LFC发育不全的概念提供了证据。
证据水平
III级，回顾性队列研究。
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