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J Arthroplasty. 2014 May;29(5):906-11. doi: 10.1016/j.arth.2013.10.024. Epub 2013 Oct 31.

Evaluation of the 3-dimensional, weight-bearing orientation of the normal adult knee.

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Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
Illinois Bone and Joint Institute, Morton Grove, Illinois.


The purpose of this study was to use 3-dimensional, weight-bearing images corrected for rotation to establish normative data of limb alignment and joint line orientation in asymptomatic, adult knees. One hundred adults (200 lower extremities) were recruited to receive weight-bearing, simultaneous biplanar imaging of both lower extremities. Multiple radiographic parameters were measured from 3D images, corrected for limb rotation. 70.0% of knees were in neutral, 19.5% in varus, and 10.5% in valgus overall alignment. Only 31 % of knees possessed both a neutral mechanical axis and the absence of joint line obliquity. There was substantial agreement between the 2D and 3D images for overall mechanical alignment (κ = 0.77), but only a moderate agreement for joint line obliquity (κ = 0.58). A substantial portion of asymptomatic adults possess either a varus or valgus mechanical alignment and joint line obliquity.


3-dimensional imaging; constitutional varus; kinematic alignment; knee; mechanical alignment

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