{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:01Z","timestamp":1789844521520,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the relationships among lower limb alignment parameters and quantitatively clarify the stage\u2010dependent contributions of bony morphology and soft tissue laxity to varus deformity across knee osteoarthritis stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 1346 knees of 673 participants in a community\u2010based cohort. Radiographic parameters, including the hip\u2013knee\u2013ankle angle (HKAA), weight\u2010bearing line ratio (WBLR), femorotibial angle (FTA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA) and joint line convergence angle, were measured using full\u2010length standing radiographs. Spearman's correlation coefficients and linear regression analyses were performed for the overall cohort and stratified subgroups: early\u2010 (Kellgren\u2013Lawrence Grade [KLG] 0\u20131), progressive\u2010 (KLG 2) and end\u2010stage (KLG 3\u20134).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the overall cohort, the HKAA exhibited robust correlations with WBLR (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and FTA (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), validating FTA as a reliable global alignment surrogate. Stage\u2010dependent analysis revealed a change in the relative associations among determinants of deformity. In the early\u2010 and progressive\u2010stage groups, varus alignment was predominantly associated with bony parameters (MPTA and LDFA). Conversely, in the end\u2010stage group, the correlation between the joint line convergence angle and varus deformity strengthened significantly (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.61 vs.\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.20 in the early stage).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While bony deformity is a consistent factor, the contribution of soft tissue laxity (joint line convergence angle) becomes substantial in end\u2010stage osteoarthritis. In end\u2010stage osteoarthritis, the joint line convergence angle is a key alignment determinant. Surgical planning for joint\u2010preserving procedures, including high tibial osteotomy, must account for this quantitative confirmation of stage\u2010dependent differences to prevent reducible soft tissue component overcorrection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70704","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T12:50:12Z","timestamp":1775479812000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Quantitative analysis of bony and soft tissue contributions to varus deformity across knee osteoarthritis stages"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-2526","authenticated-orcid":false,"given":"Kyota","family":"Ishibashi","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoto","family":"Kura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Tomita","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru Kristi","family":"Ishibashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Tsuda","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Ishibashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","unstructured":"Awang N Sulaiman R Shapi'i A Rashid AHA Amran MFM Osman S. A comparative study of computer aided system preoperative planning for high tibial osteotomy. In: Badioze Zaman H Robinson P Smeaton AF Shih TK Velastin S editors. Advances in visual informatics. IVIC 2015. Lecture notes in computer science vol. 9429. 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Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata."}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70704","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jeo2.70704","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70704","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:14:13Z","timestamp":1789841653000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/jeo2.70704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/jeo2.70704"],"URL":"https:\/\/doi.org\/10.1002\/jeo2.70704","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70704"}}