{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:30:26Z","timestamp":1792510226869,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,9,22]],"date-time":"2024-09-22T00:00:00Z","timestamp":1726963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Evaluation of long\u2010leg standing radiographs (LSR) is a standardised procedure for analysis of primary or secondary deformities of the lower limbs. Deep\u2010learning convolutional neural networks (CNN) offer the potential to enhance radiological measurement by increasing reproducibility and accuracy. This study aims to evaluate the measurement accuracy of an automated CNN\u2010based planning tool (mediCAD\u00ae 7.0; mediCAD Hectec GmbH) of lower limb deformities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a retrospective single\u2010centre study, 164 pre\u2010 and postoperative bilateral LSRs with uni\u2010 or bilateral posttraumatic knee arthritis undergoing total knee arthroplasty (TKA) were enroled. Alignment parameters relevant to knee arthroplasty and deformity correction were analysed independently by two observers and a CNN. The intraclass correlation coefficient (ICC) was used to evaluate the accuracy between observers and the CNN, which was further evaluated using absolute deviations, limits of agreement (LoA) and root mean square error (RMSE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CNN evaluation demonstrated high consistency in measuring leg length (ICC\u2009&gt;\u20090.99) and overall lower limb alignment measures of mechanical tibio\u2010femoral angle (mTFA) (ICC\u2009&gt;\u20090.97; RMSE\u2009&lt;\u20091.1\u00b0). The mean absolute difference between angular measurements were low for overall lower limb alignment (mTFA 0.49\u20130.61\u00b0) and high for specific joint angles (aMPFA 3.86\u20134.50\u00b0). Accuracy at specific joint angles like the mechanical proximal tibial angle (MPTA) and the mechanical lateral distal femur angle (mLDFA) varied between lower limbs with deformity, with and without TKA with greatest difference for TKA (ICC 0.22\u20130.85; RMSE 1.72\u20133.65\u00b0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Excellent accuracy was observed between manual and automated measurements for overall alignment and leg length, but joint\u2010level metrics need further improvement especially in case of TKA similar to other existing algorithms. Despite the observed deviations, the time\u2010efficient nature of the algorithm improves the efficiency of the preoperative planning process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12481","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T02:59:06Z","timestamp":1727060346000},"page":"1975-1981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["High accuracy in lower limb alignment analysis using convolutional neural networks, with improvements needed for joint\u2010level metrics"],"prefix":"10.1002","volume":"33","author":[{"given":"Christof","family":"Hoffmann","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih","family":"G\u00f6ksu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Reconstructive Surgery Diakonie Klinikum, GmbH Jung\u2010Stilling\u2010Krankenhaus Siegen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Kl\u00f6pfer\u2010Kr\u00e4mer","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"},{"name":"Institute for Biomechanics Paracelsus University Salzburg Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Watrinet","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Sports Medicine Technical University Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Blum","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Hungerer","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Schr\u00f6ter","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Reconstructive Surgery Diakonie Klinikum, GmbH Jung\u2010Stilling\u2010Krankenhaus Siegen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Stuby","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Augat","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"},{"name":"Institute for Biomechanics Paracelsus University Salzburg Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5529-1632","authenticated-orcid":false,"given":"Julian","family":"F\u00fcrmetz","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery BG Trauma Center Murnau Murnau Germany"},{"name":"Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2012.07.009"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7047.1654"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.11.013"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-03552-8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07302-x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpb.0000242441.96434.6f"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.03.001"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.18.20224"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/10929080600628985"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.1003488"},{"issue":"4","key":"e_1_2_12_12_1","first-page":"238","article-title":"Inter\u2010 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