{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:56:57Z","timestamp":1793235417494,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":13,"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 assess associations between coronal knee alignment and regional epiphyseal bone mineral density (BMD) using computed tomography (CT)\u2010derived Hounsfield units (HU) and compare medial\u2010to\u2010lateral ratios (MLRs) across alignment groups, and as a secondary aim, to evaluate the association of sex and demographic factors with regional BMD patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective search (2008\u20132025) identified patients with non\u2010contrast knee CT and standing anteroposterior long\u2010leg radiographs. Exclusions included prior femur or tibia fracture or surgery and metabolic bone disease other than osteopenia or osteoporosis. Mean trabecular HU were measured for medial and lateral femoral condyles (MFC, LFC), distal femur epiphysis (DFE), medial and lateral tibial plateaus (MTP, LTP) and proximal tibia epiphysis (PTE). Outcomes included DFE\u2010MLR (MFC\/LFC), PTE\u2010MLR (MTP\/LTP) and combined\u2010MLR ([MFC\u2009+\u2009MTP]\/[LFC\u2009+\u2009LTP]). Alignment was categorized by hip\u2013knee\u2013ankle angle (HKAA) as major varus, varus, neutral, valgus or major valgus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort included 312 patients (mean age 66.5\u2009\u00b1\u20099.3 years; 50.6% female); 99.4% underwent CT for robotic\u2010assisted arthroplasty planning. LFC HU exceeded MFC HU in 88.5% of cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and MTP HU exceeded LTP HU in 92.9% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Increasing valgus correlated with decreasing MLR (DFE\u2010MLR\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.459; PTE\u2010MLR\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.322; combined\u2010MLR\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.509; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Females demonstrated higher PTE\u2010MLR and combined\u2010MLR than males (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.049).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Coronal knee alignment was strongly associated with compartmental epiphyseal BMD MLR, with lower MLR in valgus alignment and greater alignment sensitivity in females. These findings provide quantitative imaging context relevant to arthroplasty planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70719","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T12:40:37Z","timestamp":1776170437000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Coronal knee alignment is directly related to knee medial\u2010to\u2010lateral bone density ratio"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-8276","authenticated-orcid":false,"given":"Craig E.","family":"Klinger","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York 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BG Klinikum Hamburg Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7050-5571","authenticated-orcid":false,"given":"Peter K.","family":"Sculco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedic Surgery Weill Cornell Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-9880","authenticated-orcid":false,"given":"Scott A.","family":"Rodeo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedic Surgery Weill Cornell Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8596-3292","authenticated-orcid":false,"given":"Elizabeth B.","family":"Gausden","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedic Surgery Weill Cornell Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-6388","authenticated-orcid":false,"given":"Hollis G.","family":"Potter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedic Surgery Weill Cornell Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedic Surgery Weill Cornell Medicine New York New York 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