{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:08:20Z","timestamp":1779365300596,"version":"3.53.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective analysis of 749\u00a0knees in consecutive patients presenting to a single\u2010centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long\u2010leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean FMA was 91.3\u2009\u00b1\u20092.2\u00b0 (range 82\u00b0\u201397\u00b0), the mean TMA was 85.7\u2009\u00b1\u20092.5\u00b0 (range 75\u00b0\u201398\u00b0), the mean aHKA was 177.0\u2009\u00b1\u20093.0\u00b0 (range 164\u00b0\u2013185\u00b0) and the mean vcHKA was 176.6\u2009\u00b1\u20093.1\u00b0 (range 165\u00b0\u2013192\u00b0). No significant difference was observed between aHKA and vcHKA (<jats:italic>p<\/jats:italic>\u2009=\u20090.06). A significant correlation was found between vcHKA and TMA (\u03c1\u2009=\u20090.3; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and between vcHKA and FMA (\u03c1\u2009=\u20090.41; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre\u2010arthritic coronal alignment of the knee for the extension gap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06832-0","type":"journal-article","created":{"date-parts":[[2022,1,10]],"date-time":"2022-01-10T19:03:06Z","timestamp":1641841386000},"page":"2915-2921","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0902-5760","authenticated-orcid":false,"given":"E.","family":"Sappey\u2010Marinier","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse 69004 Lyon France"},{"name":"<!--<label>2<\/label>--> Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 F69622 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Meynard","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse 69004 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Shatrov","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse 69004 Lyon France"},{"name":"<!--<label>3<\/label>--> Sydney Orthopaedic Research Institute Chatswood, Sydney Australia"},{"name":"<!--<label>4<\/label>--> University of Notre Dame Australia Sydney Australia"},{"name":"<!--<label>5<\/label>--> Hornsby and Ku\u2010Ring Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse 69004 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Cheze","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 F69622 Lyon 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Prof. S\u00e9bastien Lustig receives institutional research support from Corin and Amplitude. Prof. S\u00e9bastien Lustig is a board member of KSSTA, Maitrise Orthop\u00e9dique and JBJS american. The other authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 under the number 135\u20135265. All procedures performed were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}