{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:48:48Z","timestamp":1784875728418,"version":"3.55.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In restricted kinematic alignment total knee arthroplasty (TKA), bone resection is performed within a safe range to help protect against failure from extreme alignments. Patient-specific instrumentation, navigations, and robotics are often required for restricting bone cuts within a specified safe zone. We hypothesized that the lateral malleolus could be used as a landmark for restricting the tibial osteotomy using a mechanical jig. Here, we examine its feasibility in anatomical and clinical settings. We studied long-leg standing radiographs of 114 consecutive patients (228 knees) who underwent knee arthroplasty in our institution. We measured the lateral malleolus angle (LMA), the angle between the tibial axis and the line between the center of the knee and the lateral surface of the lateral malleolus. The medial proximal tibial angle was also measured before and after restricted kinematic alignment TKA under restriction with reference to the lateral malleolus. Mean LMA was 5.5\u2009\u00b1\u20090.5\u2009degrees. This was relatively consistent and independent of patient's height, weight, and body mass index. The lateral malleolus is a reliable bone landmark that can be used to recognize approximately 5.5\u2009degrees of varus intraoperatively. A surgeon can use this as a restriction of the tibial varus cut up to 6\u2009degrees without the requirement for expensive assistive technologies.<\/jats:p>","DOI":"10.1055\/a-1965-4361","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T23:07:31Z","timestamp":1666393651000},"page":"037-042","source":"Crossref","is-referenced-by-count":5,"title":["The Lateral Malleolus Is a Simple and Reliable Landmark that Can Be Used to Reliably Perform Restricted Kinematically Aligned Total Knee Arthroplasty\u2014Anatomical and Clinical Studies in Japanese Population"],"prefix":"10.1055","volume":"37","author":[{"given":"Takafumi","family":"Hiranaka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F. M.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Nuffield Orthopaedic Centre, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Fujishiro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Suda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shotaro","family":"Araki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Kamenaga","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoki","family":"Koide","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,12,31]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"3467","DOI":"10.1007\/s00167-017-4558-y","article-title":"Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty","volume":"25","author":"Y S Lee","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1007\/s11999-012-2613-z","article-title":"Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category?","volume":"471","author":"S M Howell","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3928\/01477447-20190424-02","article-title":"Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival","volume":"42","author":"S M Howell","year":"2019","journal-title":"Orthopedics"},{"key":"ref4","first-page":"279","volume-title":"Kinematically aligned total knee arthroplasty using calipered measurements, manual instruments, and verification checks","author":"A J Nedopil","year":"2020"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-24243-5_16","volume-title":"The kinematic alignment technique for total knee arthroplasty","author":"C Rivi\u00e8re","year":"2020"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11999-011-1936-5","article-title":"The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus","volume":"470","author":"J Bellemans","year":"2012","journal-title":"Clin Orthop Relat Res"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/jor.20858","article-title":"Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint","volume":"27","author":"K R Hovinga","year":"2009","journal-title":"J Orthop Res"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.2106\/JBJS.I.00969","article-title":"The offset of the tibial shaft from the tibial plateau in Chinese people","volume":"92","author":"Q Tang","year":"2010","journal-title":"J Bone Joint Surg Am"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/j.arth.2017.02.028","article-title":"The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty","volume":"32","author":"A M 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surgical technique and initial results","volume":"102","author":"J RB Hutt","year":"2016","journal-title":"Orthop Traumatol Surg Res"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1007\/s00167-020-06165-4","article-title":"Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment","volume":"30","author":"P Winnock de Grave","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"ref14","first-page":"301","volume-title":"Kinematic alignment total knee replacement with personalized instruments","author":"W G Blakeney","year":"2020"},{"issue":"09","key":"ref15","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1007\/s00402-018-2988-8","article-title":"Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials","volume":"138","author":"J 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the Australian and New Zealand Joint Replacement Registries","volume":"35","author":"A Klasan","year":"2020","journal-title":"J Arthroplasty"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.knee.2022.02.008","article-title":"Approximately 80% of Japanese osteoarthritic patients fall out of the safety range in restricted kinematically-aligned total knee arthroplasty in an analysis of preoperative long-leg radiograms","volume":"35","author":"Y Suda","year":"2022","journal-title":"Knee"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/230949900701500108","article-title":"Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning","volume":"15","author":"W P Yau","year":"2007","journal-title":"J Orthop Surg (Hong Kong)"}],"container-title":["The Journal of Knee 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