{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T03:27:55Z","timestamp":1782876475502,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2010,1,22]],"date-time":"2010-01-22T00:00:00Z","timestamp":1264118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2010,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Frontal plane knee malalignment may increase progression of knee osteoarthritis (OA) and hasten functional decline. An accurate nonradiographic measure of knee alignment is necessary because the gold standard measure, the long\u2010leg radiograph, is costly and often unavailable. Moreover, nonradiographic measures of knee alignment have not been validated in an obese population, where knee OA is common. The purpose of this study was to develop and assess the concurrent validity and reliability of a nonradiographic measure of frontal plane knee alignment and demonstrate the accuracy of the measure in an obese population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010five subjects (41 women, 14 men; mean \u00b1 SD age 62.9 \u00b1 10.3 years) with knee OA were examined. A nonradiographic measure (umbilical method) of frontal plane alignment, using the landmarks of the umbilicus, knee, and ankle, was compared with the radiograph gold standard. Statistical significance was accepted at <jats:italic>P<\/jats:italic> &lt; 0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010nine percent of the participants had a body mass index (BMI) placing them in the overweight or obese category (mean \u00b1 SD BMI for all subjects 31.3 \u00b1 6.1 kg\/m<jats:sup>2<\/jats:sup>). Radiographic measures of alignment ranged from 9.1\u00b0 valgus to 14.3\u00b0 varus (76% of the participants had varus alignment, 12% had valgus alignment, and 2% had neutral alignment). Umbilical measures ranged from 1\u00b0 valgus to 21\u00b0 varus. The umbilical measure was significantly correlated with the radiographic method (r = 0.75, <jats:italic>P<\/jats:italic> &lt; 0.001). The error of the umbilical measure was not significantly correlated with the BMI (r = \u22120.21, <jats:italic>P<\/jats:italic> = 0.13).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The umbilical method of assessing frontal plane knee alignment is a valid surrogate for the radiographic gold standard and retains its accuracy in an obese population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.20084","type":"journal-article","created":{"date-parts":[[2010,1,22]],"date-time":"2010-01-22T11:45:32Z","timestamp":1264160732000},"page":"690-696","source":"Crossref","is-referenced-by-count":18,"title":["Measurement of varus\/valgus alignment in obese individuals with knee osteoarthritis"],"prefix":"10.1002","volume":"62","author":[{"given":"Kyle","family":"Gibson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Sayers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian A.","family":"Minor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,4,29]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780300811"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.84.3.351"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.11006"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.2.188"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh017"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.21836"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.21100"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.22618"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2007.221"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200003)43:3<568::AID-ANR13>3.0.CO;2-E"},{"key":"e_1_2_6_12_2","first-page":"132","article-title":"Accuracy of a non\u2010radiographic method of measuring varus\/valgus alignment in knees with osteoarthritis","volume":"106","author":"Gibson K","year":"2009","journal-title":"Mo Med"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0049-0172(91)90026-V"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780290816"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00297-X"},{"key":"e_1_2_6_16_2","volume-title":"Differential diagnosis for physical therapists: screening for referral","author":"Goodman CC","year":"2007"},{"key":"e_1_2_6_17_2","first-page":"3","article-title":"Atlas of individual radiographic features in osteoarthritis","volume":"3","author":"Altman RD","year":"1995","journal-title":"Osteoarthritis Cartilage"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002281-200109000-00017"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780381104"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-132-3-200002010-00002"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540250033028"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-7-529"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(99)90032-1"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/anr.1780321108"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.58.1.15"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-199603000-00002"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199907)42:7<1361::AID-ANR9>3.0.CO;2-9"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-199411000-00006"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-6-27"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1520\/JFS16162J"}],"container-title":["Arthritis Care &amp; 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