{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:46:54Z","timestamp":1792590414275,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002345","name":"Eberhard Karls Universit\u00e4t T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002345","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the ankle are still to be better understood. It was therefore the aim of this study to determine the influence of osteotomies around the knee on the coronal alignment of the ankle. We hypothesize that osteotomies around the knee for correction of genu varum or valgum lead to a change of the ankle orientation in the frontal plane by valgisation or varisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Long-leg standing radiographs of 154 consecutive patients undergoing valgisation or varisation osteotomy around the knee in 2017 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip knee ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), the mechanical medial proximal tibia angle (mMPTA) and five angles around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann\u2013Whitney test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred fifty-four patients (96 males, 58 females) underwent osteotomies around the knee for coronal realignment. The mean age was 51\u2009\u00b1\u200911\u00a0years. Correction osteotomies consisted of 73 HTO, 54 DFOs, and 27 double level osteotomies. Of all osteotomies, 118 were for valgisation and 36 for varisation. For valgisation osteotomies, the mean HKA changed from 5.8\u00b0\u2009\u00b1\u20092.9\u00b0 preoperatively to\u2009\u2212\u20090.9\u00b0\u2009\u00b1\u20092.5\u00b0 postoperatively, whereas the mMPTA changed from 85.9\u00b0\u2009\u00b1\u20092.7\u00b0 to 90.7\u00b0\u2009\u00b1\u20093.1\u00b0 and the malleolar-horizontal-orientation-angle (MHA) changed from 16.4\u00b0\u2009\u00b1\u20094.2\u00b0 to 10.9\u00b0\u2009\u00b1\u20094.2\u00b0. For varisation osteotomies, the mean HKA changed from\u2009\u2212\u20094.3\u00b0\u2009\u00b1\u20093.7\u00b0 to 1.1\u00b0\u2009\u00b1\u20092.2\u00b0 postoperatively, whereas the mLDFA changed from 85.7\u00b0\u2009\u00b1\u20092.2\u00b0 to 89.3\u00b0\u2009\u00b1\u20092.3\u00b0 and the MHA changed from 8.8\u00b0\u2009\u00b1\u20095.1\u00b0 to 11.2\u00b0\u2009\u00b1\u20093.2\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Osteotomies around the knee for correction of coronal limb alignment not only lead to lateralization or medialization of the weight-bearing line at the knee but also lead to a coronal reorientation of the ankle. This can be measured at the ankle using the MHA. When planning an osteotomy around the knee for correction of genu varum or valgum, the ankle should also be appreciated\u2014especially in patients with preexisting deformities, ligament instabilities, or joint degeneration around the ankle.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-021-03016-x","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T04:03:28Z","timestamp":1622779408000},"page":"675-682","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Osteotomies around the knee lead to corresponding frontal realignment of the ankle"],"prefix":"10.1007","volume":"32","author":[{"given":"Christian","family":"Konrads","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Eis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufian S.","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"St\u00f6ckle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"D\u00f6bele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"3016_CR1","first-page":"249","volume":"34","author":"Y Kosashvili","year":"2010","unstructured":"Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D (2010) Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orhtop 34:249\u2013254","journal-title":"Int Orhtop"},{"key":"3016_CR2","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1007\/s00264-014-2435-6","volume":"38","author":"D Saragaglia","year":"2014","unstructured":"Saragaglia D, Rouchy RC, Krayan A, Refaie R (2014) Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritsi. Int Orthop 38:2109\u20132114","journal-title":"Int Orthop"},{"key":"3016_CR3","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/s00264-009-0902-2","volume":"34","author":"AE Staubli","year":"2010","unstructured":"Staubli AE, Jacob HAC (2010) Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 34:67\u2013172","journal-title":"Int Orthop"},{"key":"3016_CR4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s00264-009-0937-4","volume":"34","author":"T Benzakour","year":"2010","unstructured":"Benzakour T, Hefti A, Lemseffer M, El Ahmadi JD, Bouyarmane H, Benzakour A (2010) High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. Int Orthop 34:209\u2013215","journal-title":"Int Orthop"},{"key":"3016_CR5","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s00264-009-0944-5","volume":"34","author":"M Wolcott","year":"2010","unstructured":"Wolcott M, Traub S, Efird C (2010) High tibial osteotomies in the young active patient. Int Orthop 34:161\u2013166","journal-title":"Int Orthop"},{"key":"3016_CR6","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s00264-009-0889-8","volume":"34","author":"A Amendola","year":"2010","unstructured":"Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155\u2013160","journal-title":"Int Orthop"},{"key":"3016_CR7","doi-asserted-by":"crossref","unstructured":"Paley D, Herzenberg J (2005) Radiographic Assessment of Lower Limb Deformities. In: Principles of Deformity Correction. Springer: Berlin, Heidelberg, New York. pp 31\u201360.","DOI":"10.1007\/978-3-642-59373-4_3"},{"key":"3016_CR8","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1055\/s-0037-1603503","volume":"30","author":"S Schr\u00f6ter","year":"2017","unstructured":"Schr\u00f6ter S, Elson DW, Ateschrang A, Ihle C, St\u00f6ckle U, Dickschas J, Harrer J (2017) Lower limb deformity analysis and the planning of an osteotomy. J Knee Surg 30:393\u2013408","journal-title":"J Knee Surg"},{"issue":"Suppl2","key":"3016_CR9","doi-asserted-by":"publisher","first-page":"B55","DOI":"10.1016\/j.injury.2003.09.025","volume":"34","author":"AE Staubli","year":"2003","unstructured":"Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia: early results in 92 cases. Injury 34(Suppl2):B55-62","journal-title":"Injury"},{"key":"3016_CR10","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1007\/s00167-002-0334-7","volume":"11","author":"P Lobenhoffer","year":"2003","unstructured":"Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132\u2013138","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3016_CR11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s00132-003-0593-0","volume":"33","author":"P Lobenhoffer","year":"2004","unstructured":"Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fiation by medial plate fixator. Orthopade 33:153\u2013160","journal-title":"Orthopade"},{"key":"3016_CR12","doi-asserted-by":"publisher","first-page":"712","DOI":"10.2106\/00004623-200005000-00012","volume":"82","author":"T St\u00e4helin","year":"2000","unstructured":"St\u00e4helin T, Hardegger F, Ward JC (2000) Supracondylar osteotomy of the femur with use of compression: osteosynthesis with a malleable implant. J Bone Joint Surg Am 82:712\u2013722","journal-title":"J Bone Joint Surg Am"},{"key":"3016_CR13","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1007\/s00167-012-2133-0","volume":"21","author":"J Visser","year":"2013","unstructured":"Visser J, Brinkman JM, Bleys RL, van Heerwaarden CRM, RJ, (2013) The safety and feasibility of a less invasive distal femur closing wedge osteotomy technique: a cadaveric dissection study of the medial aspect of the distal femur. Knee Surg Sports Traumatol Arthrosc 21:220\u2013227","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3016_CR14","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s00064-017-0493-9","volume":"29","author":"P Lobenhoffer","year":"2017","unstructured":"Lobenhoffer P, Kley K, Freiling D, van Heerwaarden R (2017) Medial closed wedge osteotomy of the distal femur in biplanar technique and a specific plate fixator. Oper Orthop Traumatol 29:306\u2013319","journal-title":"Oper Orthop Traumatol"},{"key":"3016_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40634-014-0001-1","volume":"1","author":"J-M Brinkman","year":"2014","unstructured":"Brinkman J-M, Hurschler C, Agneskirchner J, Lobenhoffer P, Castelein RM, van Heerwaarden RJ (2014) Biomechanical testing of distal femur osteotomy plate fixation techniques. J Exp Orthop 1:1\u20137","journal-title":"J Exp Orthop"},{"key":"3016_CR16","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s00402-018-3068-9","volume":"139","author":"S Schr\u00f6ter","year":"2019","unstructured":"Schr\u00f6ter S, Nakayama H, Yoshiya S, St\u00f6ckle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique loint line. Arch Orthop Trauma Surg 139:519\u2013527","journal-title":"Arch Orthop Trauma Surg"},{"key":"3016_CR17","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1712945","author":"X Jiang","year":"2020","unstructured":"Jiang X, Xie K, Han X, Ai S, Wu H, Wang L, Yan M (2020) HKA Angle-A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs. J Knee Surg. https:\/\/doi.org\/10.1055\/s-0040-1712945","journal-title":"J Knee Surg"},{"key":"3016_CR18","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.knee.2020.04.018","volume":"27","author":"S Bartholomeeusen","year":"2020","unstructured":"Bartholomeeusen S, Van den Bempt M, van Beek N, Claes T, Claes S (2020) Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment. Knee 27:777\u2013786","journal-title":"Knee"},{"issue":"1","key":"3016_CR19","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s00264-020-04799-0","volume":"45","author":"JG Kim","year":"2020","unstructured":"Kim JG, Suh DH, Choi GW, Koo BM, Kim S-G (2020) Change in weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity. Int Orthop 45(1):117\u2013124","journal-title":"Int Orthop"},{"issue":"86","key":"3016_CR20","first-page":"93","volume":"39","author":"MG Kyung","year":"2021","unstructured":"Kyung MG, Cho YJ, Hwang S, Lee D-O, Lee MC, Lee DY (2021) Change in intersegmental foot and ankle motion after a gigh tibial osteotomy in genu varum patients. J Orthop Res 39(86):93","journal-title":"J Orthop Res"},{"issue":"2","key":"3016_CR21","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00264-020-04809-1","volume":"45","author":"W Wang","year":"2020","unstructured":"Wang W, Ding R, Zhang N, Hernigou P (2020) Subchondral bone cysts regress after correction of malalignment in knee osteoarthritis: comply with Wolff\u2019s law. Int Orthop 45(2):445\u2013451","journal-title":"Int Orthop"},{"key":"3016_CR22","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.knee.2008.02.002","volume":"15","author":"R Takeuchi","year":"2008","unstructured":"Takeuchi R, Saito T, Koshino T (2008) Clinical results of a valgus high tibial osteotomy for the treatment of osteoarthritis of the knee and the ipsilateral ankle. Knee 15:196\u2013200","journal-title":"Knee"},{"key":"3016_CR23","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1007\/s00167-015-3890-3","volume":"25","author":"GW Choi","year":"2017","unstructured":"Choi GW, Yank JH, Park JH, Yun HH, Lee YI, Chae JE, Yoon JR (2017) Changes in coronal alignment of the ankle joint after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:838\u2013845","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3016_CR24","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1177\/1071100718773767","volume":"39","author":"JY Choi","year":"2018","unstructured":"Choi JY, Song SJ, Kim SJ, Kim SH, Park JS, Suh JS (2018) Changes iin hindfoot alignment after high or low tibial osteotomy. Foot Ankle Int 39:1097\u20131105","journal-title":"Foot Ankle Int"},{"key":"3016_CR25","doi-asserted-by":"publisher","first-page":"7656878","DOI":"10.1155\/2019\/7656878","volume":"2019","author":"K Yoshimoto","year":"2019","unstructured":"Yoshimoto K, Noguchi M, Yamada A, Nasu Y (2019) Compensatory function of the subtalar joint for lower extremity malalignment. Adv Orthop 2019:7656878. https:\/\/doi.org\/10.1155\/2019\/7656878","journal-title":"Adv Orthop"},{"key":"3016_CR26","doi-asserted-by":"publisher","first-page":"3758","DOI":"10.1007\/s00167-019-05812-9","volume":"28","author":"F Graef","year":"2020","unstructured":"Graef F, Falk R, Tsitsilonis S, Parka C, Zahn RK, Hommel H (2020) Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function. Knee Surg Sports Traumatol Arthrosc 28:3758\u20133765","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3016_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06246-4","author":"F Graef","year":"2020","unstructured":"Graef F, Hommel H, Falk R, Tsitsilonis S, Zahn RK, Perka C (2020) Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms. Knee Surg Sports Traumatol Arthrosc. https:\/\/doi.org\/10.1007\/s00167-020-06246-4","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"3016_CR28","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1007\/s00590-008-0353-2","volume":"18","author":"V Mounasamy","year":"2008","unstructured":"Mounasamy V, Sambandam S (2008) Surgical managementn of young arthritic knee: a review. Eur J Orthop Surg Traumatol 18:555\u2013564","journal-title":"Eur J Orthop Surg Traumatol"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-021-03016-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-021-03016-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-021-03016-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T04:30:14Z","timestamp":1649651414000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-021-03016-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,4]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["3016"],"URL":"https:\/\/doi.org\/10.1007\/s00590-021-03016-x","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,4]]},"assertion":[{"value":"22 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declaration"}},{"value":"The author declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}