{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T20:46:34Z","timestamp":1770065194293,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Joint line obliquity is crucial for the long\u2010term success of a high tibial osteotomy (HTO), particularly when large corrections are made. The relationship between the size of correction and changes in joint line obliquity (KJLO) is complex, often leading to the preference for a double\u2010level osteotomy to manage significant post\u2010operative obliquity. We aim to improve the prediction of knee joint line orientation changes and correction size by examining the influence of foot position. The goal is to develop a linear model to predict post\u2010operative KJLO, which could assist in determining whether a single\u2010 or double\u2010level osteotomy is necessary to prevent excessive post\u2010operative joint line obliquity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective radiographic analysis was conducted on patients who underwent HTO surgery between April 2016 and April 2017. Ninety\u2010one patients were randomly selected for radiographic measurements on long\u2010leg radiographs pre\u2010 and 3\u2010month post\u2010operative. A novel radiographic parameter was introduced to realign the foot of the operated side to the midline. The foot position relative to the midline was assessed by determining the angle formed when rotating the natural foot position onto the midline using the centre of the hip as a rotation point. The angle obtained by subtracting this from the KJLO results in a corrected KJLO for midline foot position (aKJLO).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Predictive model of differences between pre\u2010 and post\u2010operative values of MPTA (\u0394MPTA [medial proximal tibial angle]) and KJLO (\u0394KJLO) was less predictive (0.185 [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]) than \u0394MPTA and \u0394KJLO corrected for foot position, namely \u0394aKJLO (0.688 [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]). Adding more parameters did not significantly improve the linear model's predictions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Predictability of aKJLO could be significantly enhanced. With this new parameter, inter\u2010 and intra\u2010variability of foot position is bypassed. A safe MPTA position of 91\u00b0 can be presumed; however, inter\u2010individual variability in limb adaptation following correction remains uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12598","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T04:24:33Z","timestamp":1738556673000},"page":"2447-2454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving predictability of post\u2010operative knee joint line obliquity in high tibial osteotomy: A new radiographic parameter correcting for foot position"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1256-5183","authenticated-orcid":false,"given":"M.","family":"Mertens","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2806-4682","authenticated-orcid":false,"given":"N.","family":"van Beek","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology University Hospitals Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9284-2210","authenticated-orcid":false,"given":"T.","family":"Claes","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8910-7266","authenticated-orcid":false,"given":"W. J.","family":"Vleugels","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Nys","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8612-6768","authenticated-orcid":false,"given":"S.","family":"Claes","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"},{"name":"Department of Orthopedics and Traumatology University Hospitals Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6301-0009","authenticated-orcid":false,"given":"S.","family":"Bartholomeeusen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery AZ Herentals Herentals Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2007.05.018"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B5.20386"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2122-3"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200208000-00014"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2020.04.018"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)31922-2"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07611-9"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-024-05254-0"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4045-x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2019.08.003"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.12.007"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05765-z"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453678008990901"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1515\/bmt-2015-0221"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07581-y"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.11.001"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-002-0334-7"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2024.103949"},{"issue":"12","key":"e_1_2_12_20_1","first-page":"1092","article-title":"Double tibial osteotomy for bow leg patients: A case series","volume":"18","author":"Nazem K","year":"2013","journal-title":"J Res Med Sci"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1571430"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07518-5"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)31927-1"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-019-2820-9"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1530\/EOR-24-0037"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0b013e318172b562"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1256-4"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1584189"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07505-w"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.84B2.0840223"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T13:24:22Z","timestamp":1760880262000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,3]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ksa.12598"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12598","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,3]]},"assertion":[{"value":"2024-09-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}