TY - JOUR
T1 - A structured framework for standardized 3D leg alignment analysis
T2 - an international Delphi consensus study
AU - Veerman, Quinten W. T.
AU - Tuijthof, Gabriëlle J. M.
AU - Verdonschot, Nico
AU - Brouwer, Reinoud W.
AU - Verdonk, Peter
AU - van Haver, Annemieke
AU - van der Veen, Hugo C.
AU - Pijpker, Peter A. J.
AU - Heuvel, Judith olde
AU - Hoogeslag, Roy A. G.
AU - Erdemir, Ahmet
AU - Perrier, Antoine
AU - Sigrist, Bastian
AU - Innocenti, Bernardo
AU - Imhauser, Carl W.
AU - Belvedere, Claudio
AU - Vuurberg, Gwendolyn
AU - Weinans, Harrie
AU - Fürmetz, Julian
AU - Carman, Laura
AU - Blankevoort, Leendert
AU - Taylor, Mark
AU - Donnez, Mathias
AU - Feucht, Matthias J.
AU - Ollivier, Matthieu
AU - Hirschmann, Michael T.
AU - Jung, Min
AU - Tanoğlu, Oguzhan
AU - Niemeyer, Philipp
AU - Khakha, Raghbir
AU - Custers, Roel J. H.
AU - van Heerwaarden, Ronald
AU - Kuiper, Ruurd J. A.
AU - Fucentese, Sandro F.
AU - Claes, Steven
AU - Besier, Thor F.
AU - León-Muñoz, Vicente J.
AU - Petersen, Wolf
AU - van Genechten, Wouter
AU - the 3D Leg Alignment Consensus Expert Group
AU - Teng, Yuanjun
N1 - Publisher Copyright:
© 2025 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
PY - 2025/6
Y1 - 2025/6
N2 - Purpose: To reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability. Methods: A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement. Results: Rounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion. Conclusions: This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni- and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross-study comparability. Level of Evidence: Level V.
AB - Purpose: To reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability. Methods: A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement. Results: Rounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion. Conclusions: This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni- and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross-study comparability. Level of Evidence: Level V.
KW - alignment parameters
KW - consensus
KW - coordinate systems
KW - joint orientation
KW - knee
UR - https://www.scopus.com/pages/publications/105003376838
U2 - 10.1002/ksa.12676
DO - 10.1002/ksa.12676
M3 - Article
C2 - 40238190
SN - 0942-2056
VL - 33
SP - 2276
EP - 2292
JO - Knee surgery, sports traumatology, arthroscopy
JF - Knee surgery, sports traumatology, arthroscopy
IS - 6
ER -