{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:18:04Z","timestamp":1783437484409,"version":"3.54.6"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"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":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The role of coronal alignment in primary anterior cruciate ligament (ACL) tears remains unclear. Coronal alignment phenotypes in ACL\u2010injured patients and healthy controls were compared using Hirschmann's functional classification and the coronal plane alignment of the knee (CPAK) system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 192 patients with unilateral ACL tears and 193 age\u2010 and sex\u2010matched healthy controls were compared. Full\u2010length standing radiographs were analysed using mediCAD software to measure hip\u2013knee\u2013ankle (HKA) angle, femoral mechanical angle (FMA), tibial mechanical angle (TMA) and joint line convergence angle (JLCA). Knees were classified according to Hirschmann's functional phenotypes and CPAK system. Group comparisons used chi\u2010square and\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests; paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests compared ACL\u2010injured and contralateral intact knees (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 384 knees from ACL\u2010injured patients and 386 knees from controls were compared with no demographic differences. Paired analyses revealed significant differences in HKA (ACL\u2010intact minus ACL\u2010injured mean difference, 0.45\u00b0; 95% CI, 0.03\u20130.87\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034) and JLCA (ACL\u2010injured minus ACL\u2010intact mean difference, 0.46\u00b0; 95% confidence interval [CI], 0.28\u20130.64\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) between injured and intact knees. Healthy knees were predominantly varus (65.0%), while ACL\u2010injured knees shifted toward neutral (43.8%) and valgus (21.9%), with varus decreasing to 34.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cram\u00e9r's\n                      <jats:italic>v<\/jats:italic>\n                      \u2009=\u20090.33). ACL\u2010intact knees demonstrated an intermediate distribution (35.9% varus, 50.6% neutral, 13.5% valgus). CPAK type II predominated in patients, whereas type I was most common in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Valgus\u2010associated CPAK phenotypes (types III and VI) were more frequent in ACL\u2010injured knees than in ACL\u2010intact and healthy knees.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary ACL tear was associated with a shift from varus\u2010dominant alignment toward more neutral and valgus phenotypes. The intermediate phenotype distribution observed in contralateral ACL\u2010intact knees is consistent with a possible bilateral constitutional predisposition, whereas the greater shift in ACL\u2010injured knees suggests an additional injury\u2010related or post\u2010injury component. These findings should be interpreted as associations rather than evidence of pre\u2010injury causal mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, cross\u2010sectional comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70521","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:08:49Z","timestamp":1783436929000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary anterior cruciate ligament tears are associated with a shift from varus\u2010dominant to neutral and valgus coronal alignment phenotypes"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-7777","authenticated-orcid":false,"given":"Seyed Mohammad Javad","family":"Mortazavi","sequence":"first","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7964-1163","authenticated-orcid":false,"given":"Mohammadreza","family":"Razzaghof","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5335-3235","authenticated-orcid":false,"given":"Mohammad","family":"Soleimani","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3335-959X","authenticated-orcid":false,"given":"Hesan","family":"Rezaee","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1691-5554","authenticated-orcid":false,"given":"Hamed","family":"Naghizadeh","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirsadegh","family":"Mortazavi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2158-0484","authenticated-orcid":false,"given":"Mohammad Ayati","family":"Firoozabadi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center Tehran University of Medical Sciences Tehran Iran"},{"name":"Department of Orthopedic Surgery Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran 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