JPM | Free Full-Text | Only 26% of Native Knees Show an Identical Coronal Functional Knee Phenotype in the Contralateral Knee

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JPM | Free Full-Text | Only 26% of Native Knees Show an Identical Coronal Functional Knee Phenotype in the Contralateral Knee


The persistence of dissatisfaction rates among patients undergoing total knee arthroplasty (TKA) despite numerous advancements in orthopedics has prompted a reevaluation of the conventional mechanical alignment paradigm [1,2,3,4]. Recent inquiries into refining outcomes have challenged the long-standing gold standard of mechanical alignment in knee surgeries [5,6,7,8,9].
Hirschmann et al. catalyzed this discussion by introducing and applying a coronal functional knee phenotype classification, allowing for a meticulous evaluation of patient-specific knee anatomy [5,6,7,8]. The research revealed that knee phenotypes representative of mechanical alignment were notably scarce, identified in only 5.6% of men and 3.6% of women. Similarly, knee phenotypes indicative of anatomical alignment were found in just 18% of men and 17% of women [8]. However, a direct determination of native alignment and morphology from knees affected by osteoarthritis (OA) poses considerable challenges [5,9,10,11]. Exploring the existence of significant symmetry between knees on opposite sides has emerged as a potential simplification in pre-operative planning for TKA and realignment procedures [12]. Several studies, ranging from cadaveric investigations to imaging analyses, have suggested the likelihood of similarities in contralateral morphometric parameters within lower limbs [13,14,15]. Furthermore, insights from Nedopil et al. demonstrated that utilizing the alignment of the opposite knee as a reference for coronal alignment led to a substantial improvement in patient-reported function among kinematically aligned (KA) TKA patients [16]. Similarly, Mullaji et al. highlighted the reliability and validity of assessing lower limb alignment by comparing it with the unaffected limb on the opposite side [17]. Beckers et al., in contrast, observed no discernible symmetry between both knees in the coronal plane [18]. Amid these affirmations, the picture remains inconclusive. This disparity in findings underscores the complexity of ascertaining consistent bilateral knee alignment when discussing the coronal plane, where a consensus eludes researchers. Firstly, differences in imaging modalities used to assess coronal plane alignment can yield divergent results [19]. Additionally, variations in the assessment of knee morphometric parameters between standing and supine positions may also contribute to discrepancies [20]. Moreover, while some studies focus on healthy knees, the inclusion of individuals with underlying conditions or varying levels of joint health can further complicate interpretations [13,15,17]. Furthermore, factors such as age, gender, and biomechanical variations can also contribute to the observed variability in knee alignment studies [21]. Moreover, a noteworthy observation across these studies is the predominant focus on the coronal plane, with limited inclusion of analyses on the axial and sagittal planes, primarily owing to the prevalent use of long-leg radiographs [16,17,18]. Assessing axial and sagittal planes alongside the coronal one is crucial for producing a comprehensive evaluation and optimal outcomes in knee joint altering surgical interventions such as TKA and osteotomies. Understanding knee morphology in three dimensions allows for a more accurate alignment and biomechanical restoration, which are essential for long-term success and patient satisfaction [19,22]. Axial parameters, pertaining to torsion and rotation, influence patellofemoral tracking and stability, affecting postoperative function and implant longevity [22,23]. Sagittal parameters play a significant role in knee flexion, stability, and range of motion [24]. Neglecting these dimensions can lead to complications like instability, malalignment, and premature implant wear [25]. However, a comprehensive exploration evaluating left-to-right knee symmetry across all anatomical planes utilizing three-dimensional (3D) scans stands absent from the existing body of research. This significant research gap emphasizes the need for a comprehensive study probing into knee symmetry across all anatomical planes, employing advanced 3D scans. Such an investigation can potentially identify nuanced symmetrical patterns or disparities, offering insights into native knee morphology and alignment beyond the confines of the coronal plane. This expanded understanding can transform pre-operative planning strategies and enhance the precision of knee surgeries, ultimately improving patient outcomes and satisfaction in the realm of TKA and realignment procedures.

Therefore, the aim of this present study was to check for potential differences and similarities in alignment and structure between the left and right non-osteoarthritic (native) knees in various planes (coronal, sagittal, and axial) using three-dimensional single-photon emission computed tomography/computed tomography (SPECT/CT) images. The hypothesis was that a strict symmetry between left and right native knees does not exist in any of the three anatomical planes. However, several morphometric parameters might display a high degree of left-to-right resemblance.


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