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Related Concept Videos

Knee Joint01:23

Knee Joint

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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...
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Articles linked to this work by shared authors, journal, and citation graph.

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Modification of the coronal plane alignment of the knee classification considering the joint line convergence angle in high tibial osteotomy: a geometric approach.

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Clinical outcomes after medial open-wedge high tibial osteotomy are not affected by joint space in extension and flexion on standing radiographs.

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Posterior Tibial Slope Is Associated With the Chondral Wear Pattern of the Medial Tibial Plateau.

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Bilateral anterior cruciate ligament reconstruction is more vulnerable to graft failure than unilateral anterior cruciate ligament reconstruction.

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Related Experiment Video

Updated: Jan 17, 2026

Anterior Cruciate Ligament Transection and Synovial Fluid Lavage in a Rodent Model to Study Joint Inflammation and Posttraumatic Osteoarthritis
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Radiographic Risk Factors for Excessive Joint Line Obliquity After Knee Osteotomy for Medial Osteoarthritis: A

Jaejung Ryu1, Bum-Sik Lee1, Jong-Min Kim1

  • 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Orthopaedic Journal of Sports Medicine
|September 15, 2025
PubMed
Summary

High tibial osteotomy (HTO) can lead to excessive joint line obliquity (JLO), impacting outcomes. Preoperative knee alignment phenotypes, particularly type IV, and specific radiographic measures like mLDFA and aJLO, predict this risk.

Keywords:
high tibial osteotomyjoint line obliquityknee alignmentmodified CPAK classificationosteoarthritisphenotype analysisvarus alignment

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Area of Science:

  • Orthopedic surgery
  • Biomechanical analysis
  • Radiographic assessment

Background:

  • Excessive joint line obliquity (JLO) post-high tibial osteotomy (HTO) is linked to poor clinical outcomes.
  • Phenotype analysis offers a method to classify knee alignment, including JLO, but pre- and post-operative changes are understudied.
  • Realignment osteotomy aims to correct knee deformities, making phenotype shifts crucial to understand.

Purpose of the Study:

  • To analyze preoperative and postoperative knee alignment phenotypes in patients undergoing primary realignment osteotomy for medial compartmental osteoarthritis.
  • To determine the incidence of excessive postoperative JLO and identify radiographic risk factors.
  • To investigate the relationship between preoperative phenotypes and the development of excessive JLO.

Main Methods:

  • A cross-sectional study included 348 knees from patients with varus deformity undergoing primary realignment osteotomy.
  • Coronal-plane alignment was assessed preoperatively and at 1 year postoperatively using standing scanograms and classified into 9 phenotypes.
  • Receiver operating characteristic (ROC) analysis identified preoperative radiographic parameters (mLDFA, aJLO) as risk factors for excessive JLO (>4°).

Main Results:

  • The most common preoperative phenotype was type I (42.8%), shifting to type VI postoperatively (53.7%).
  • Preoperative type IV (varus and apex neutral) showed a significantly higher incidence of excessive postoperative JLO (14.5%) compared to other types.
  • Preoperative mechanical lateral distal femoral angle (mLDFA) ≥90.2° and arithmetic JLO (aJLO) ≥-1.5° were significant predictors of excessive postoperative JLO.

Conclusions:

  • Preoperative knee alignment phenotype, especially type IV, is associated with an increased risk of excessive postoperative JLO after HTO.
  • Specific radiographic thresholds (mLDFA ≥90.2° or aJLO ≥-1.5°) identify patients at higher risk for excessive JLO.
  • These findings aid in patient selection and surgical planning to mitigate poor clinical outcomes associated with JLO after HTO.