High variability exists in 3D leg alignment analysis, but underlying principles that might lead to agreement on a universal framework could be identified: A systematic review

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-10-26 DOI:10.1002/ksa.12512

Quinten W. T. Veerman, Romy M. ten Heggeler, Gabriëlle J. M. Tuijthof, Feike de Graaff, René Fluit, Roy A. G. Hoogeslag

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Abstract

Purpose

To (1) investigate the hypothesis that there is high variability in the reported methods to derive axes and joint orientations from three-dimensional (3D) bone models to (a) perform 3D knee-related leg alignment analysis and (b) define coordinate systems for the femur, tibia and leg and (2) identify underlying principles that might lead to agreement on a universal 3D leg alignment analysis framework.

Methods

A systematic review of the literature between January 2006 and June 2024 was performed. Articles explicitly reporting methods to derive axes and joint orientations from CT-based 3D bone models for alignment parameters and/or coordinate systems of the femur, tibia and leg were included. Study characteristics and reported methods were extracted and presented as a qualitative synthesis.

Results

A total of 93 studies were included. There was high variability in the reported methods to derive axes and joint orientations from 3D bone models. Nevertheless, the reported methods could be categorized into four groups, and several underlying principles of the four groups could be identified. Furthermore, the definitions of femoral and tibial coordinate systems were most frequently based on the mechanical axis (femoral, 13/19 [68%]; tibial, 13/26 [50%]) and a central medial-lateral axis (femoral, 16/19 [84%]; tibial, 12/26 [46%]); no leg coordinate system was reported. Interestingly, of the included studies that reported on leg alignment parameters (76/93, 82%), only a minority reported expressing these in a complete coordinate system (25/76, 33%).

Conclusion

There is high variability in 3D knee-related leg alignment analysis. Therefore, universal 3D reference values for alignment parameters cannot yet be defined, and comparison of alignment parameter values between different studies is impossible. However, several underlying principles to the reported methods were identified, which could serve to reach more agreement on a future universal 3D framework for leg alignment analysis.

Level of Evidence

Level I.

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三维腿部配准分析存在很大的差异，但可以确定一些基本原则，从而就通用框架达成一致：系统综述。

目的：(1) 研究从三维（3D）骨骼模型推导轴线和关节方向的方法存在很大差异的假设，以便(a) 进行与膝关节相关的三维腿部对齐分析和(b) 为股骨、胫骨和腿部定义坐标系；(2) 确定可能导致就通用三维腿部对齐分析框架达成一致的基本原则：对 2006 年 1 月至 2024 年 6 月期间的文献进行了系统性回顾。方法：对 2006 年 1 月至 2024 年 6 月期间的文献进行了系统性综述，纳入了明确报道从基于 CT 的三维骨骼模型中推导出股骨、胫骨和腿部对齐参数和/或坐标系的轴和关节方向的方法的文章。对研究特点和报告方法进行了提取，并以定性综述的形式呈现：结果：共纳入 93 项研究。所报告的从三维骨骼模型中推导轴和关节方向的方法差异很大。不过，所报道的方法可分为四类，并可确定四类方法的若干基本原则。此外，股骨和胫骨坐标系的定义最常见的是基于机械轴（股骨，13/19 [68%]；胫骨，13/26 [50%]）和中央内外侧轴（股骨，16/19 [84%]；胫骨，12/26 [46%]）；没有关于腿部坐标系的报道。有趣的是，在纳入的报告了腿部对齐参数的研究中（76/93，82%），只有少数报告了这些参数在完整坐标系中的表达（25/76，33%）：结论：与膝关节相关的腿部三维对齐分析存在很大差异。结论：与膝关节相关的腿部三维对齐分析存在很大的变异性，因此目前还无法确定对齐参数的通用三维参考值，也无法对不同研究的对齐参数值进行比较。然而，我们发现了报告方法的几项基本原则，这有助于未来就腿部对齐分析的通用三维框架达成更多共识：证据等级：一级（1）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).