Subscribe to RSS
The Linear Coronal Knee Offset (LCKO)—Preliminary Study of New Method of Measuring Knee Varus/Valgus MalalignmentFunding None.
Introduction Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described.
Purpose In this study, we illustrate a new linear measurement: The linear coronal knee offset (LCKO) that can be used to analyze the coronal configuration on long leg alignment radiographs commonly undertaken during preoperative templating.
Methods A retrospective search was performed of our Picture Archiving and Communication System and Radiology Information System to identify 100 lower limbs anteroposterior, weight bearing, long leg alignment view radiographs of patients referred to knee clinics over 1 year with knee pain.
Demographic details, clinical indication, standard radiological measurement of the anatomical tibiofemoral angle, and the LCKO were measured and data were analyzed using Student's t-test. In addition, intraclass correlation coefficient was used to analyze for intraclass reliability.
Results The average age of patients was 36.3 years (range: 12–80 years) with a male predominance. The LCKO was statistically significant between the three cohorts of patients. The mean LCKO in normal cohorts was 0.24 cm, varus was −0.6 cm, and valgus was 1.72cm. There was good inter and interobserver reliability (Kappa of 0.8 and 0.8, respectively).
Conclusion The novel LCKO measurement provides a simpler method in assessing coronal lower limb malalignment and can easily identify a normal, varus, or valgus knee deformity.
Keywordsalignment - tibiofemoral angle - preoperative templating - total knee arthroplasty - reliability
Article published online:
26 June 2023
© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L. The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum 2002; 46 (10) 2632-2636
- 2 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286 (02) 188-195
- 3 Cooke TD, Li J, Scudamore RA. Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am 1994; 25 (03) 387-393
- 4 Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 1987; 69 (05) 745-749
- 5 Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 1990; ; ( (255) 215-227
- 6 Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am 1994; 25 (03) 367-377
- 7 Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994; ; ( (299) 153-156
- 8 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6, Suppl): 39-43
- 9 Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009; 24 (04) 570-578
- 10 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (01) 77-79
- 11 Cooke TD, Scudamore RA, Bryant JT, Sorbie C, Siu D, Fisher B. A quantitative approach to radiography of the lower limb. Principles and applications. J Bone Joint Surg Br 1991; 73 (05) 715-720
- 12 Prakash U, Wigderowitz CA, McGurty DW, Rowley DI. Computerised measurement of tibiofemoral alignment. J Bone Joint Surg Br 2001; 83 (06) 819-824
- 13 Sled E, Costigan P, Cooke TDV, Sheehy L, Hundt H, Qiu M. Measuring malalignment in knee OA. Osteoarthritis Cartilage 2005; 13: S120
- 14 Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res 1985; (192) 13-22
- 15 Tang WM, Zhu YH, Chiu KY. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg Am 2000; 82 (11) 1603-1608
- 16 Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 1987; 69 (05) 745-749
- 17 Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987; 69 (03) 332-354
- 18 Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br 2008; 90 (09) 1121-1127
- 19 Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470 (01) 45-53
- 20 Lin Y-H, Chang F-S, Chen K-H, Huang K-C, Su K-C. Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment. BMC Musculoskelet Disord 2018; 19 (01) 411
- 21 Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB. Phenotyping of hip-knee-ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1378-1384
- 22 Willcox NM, Clarke JV, Smith BR, Deakin AH, Deep K. A comparison of radiological and computer navigation measurements of lower limb coronal alignment before and after total knee replacement. J Bone Joint Surg Br 2012; 94 (09) 1234-1240
- 23 Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF. Does axial limb rotation affect the alignment measurements in deformed limbs?. Clin Orthop Relat Res 2000; ; ( (371) 246-252
- 24 Koshino T, Takeyama M, Jiang LS, Yoshida T, Saito T. Underestimation of varus angulation in knees with flexion deformity. Knee 2002; 9 (04) 275-279