{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:26:29Z","timestamp":1789194389530,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T00:00:00Z","timestamp":1710806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The present study focuses on testing the capability of a restricted tibia\u2010first, gap\u2010balanced patient\u2010specific alignment technique (PSA) to restore bony morphology and phenotypes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three\u2010hundred and sixty\u2010seven patients were treated with navigated total knee arthroplasty\u00a0and tibia\u2010first gap\u2010balanced PSA technique. Boundaries for medial proximal tibial angle were 86\u00b0\u201392\u00b0, mechanical lateral distal femoral angle 86\u00b0\u201392\u00b0, and hip\u2013knee\u2013ankle angle\u00a0175\u00b0\u2013183\u00b0. Knees were classified by coronal plane alignment of the knee (CPAK), with subsequent analyses comparing pre\u2010 and postoperative distributions. Phenotype classification within CPAK groups assessed pre\u2010 and postoperative distributions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Preoperatively, the largest CPAK group was type II (30.8%), followed by type I (20.5%) and type V (17.8%). Postoperatively, type II remained the largest group (39%), followed by type V (30%). All groups with varus\/valgus deformities (I, III, IV and VI) became smaller. While in straight legs (II, IV), the CPAK was restored in more than 70%\u201375%, in varus groups (I, IV) in 40%\u201350%\u00a0and in valgus (III and VI) in 5%\u201318%. The joint line obliquity remained the same in the majority of knees (straight &gt;75%; varus 63%\u201380%; valgus VI 95%), with the exception of CPAK III (40%). The phenotype analysis showed for straight legs a phenotype restoration of 85%, for varus 94% and for valgus 37%. Joint line convergence angle\u00a0was reduced significantly in all groups from 1.8\u00b0\u20134.3\u00b0 preoperatively to 0.6\u00b0\u20131.2\u00b0 postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PSA restores bony phenotypes and joint line obliquity in the majority of straight and varus knees, while most of the valgus and extreme varus knees are normalised.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III, retrospective cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12145","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T02:19:21Z","timestamp":1710901161000},"page":"1287-1297","source":"Crossref","is-referenced-by-count":62,"title":["Tibia\u2010first, gap\u2010balanced patient\u2010specific alignment restores bony phenotypes and joint line obliquity in a great majority of varus and straight knees and normalises valgus and severe varus 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