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<p>Coronal and sagittal malalignment represent important and often underrecognized factors in ligamentous knee instability. Varus and valgus deformities, as well as alterations in the sagittal plane (posterior tibial slope [PTS]), significantly affect tibiofemoral kinematics and lead to substantial changes in ligament loading. The PTS is a&#xa0;key risk factor: an increased PTS promotes anterior tibial translation and increases the risk of anterior cruciate ligament (ACL) insufficiency and graft failure, whereas a&#xa0;decreased slope is associated with increased posterior translation and higher loading of the posterior cruciate ligament (PCL). In addition, rotational deformities may further compromise joint stability and should be considered, particularly in complex instability patterns. Standardized radiographic alignment analysis, including long-leg weight-bearing radiographs and lateral imaging of the lower leg, is the basis of diagnostic assessment. The combined evaluation of mechanical alignment, joint-related angles, and ligamentous stability enables accurate characterization of instability and supports therapeutic decision-making. A&#xa0;systematic assessment of alignment is therefore essential for preoperative planning and may justify additional corrective osteotomy procedures.</p>

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Diagnostik des Malalignments im Kontext ligamentärer Knieinstabilitäten – Welche Diagnostik ist notwendig und wie wird sie interpretiert?

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Alexander Korthaus,
  • Jörg Harrer,
  • Felix Ferner

摘要

Coronal and sagittal malalignment represent important and often underrecognized factors in ligamentous knee instability. Varus and valgus deformities, as well as alterations in the sagittal plane (posterior tibial slope [PTS]), significantly affect tibiofemoral kinematics and lead to substantial changes in ligament loading. The PTS is a key risk factor: an increased PTS promotes anterior tibial translation and increases the risk of anterior cruciate ligament (ACL) insufficiency and graft failure, whereas a decreased slope is associated with increased posterior translation and higher loading of the posterior cruciate ligament (PCL). In addition, rotational deformities may further compromise joint stability and should be considered, particularly in complex instability patterns. Standardized radiographic alignment analysis, including long-leg weight-bearing radiographs and lateral imaging of the lower leg, is the basis of diagnostic assessment. The combined evaluation of mechanical alignment, joint-related angles, and ligamentous stability enables accurate characterization of instability and supports therapeutic decision-making. A systematic assessment of alignment is therefore essential for preoperative planning and may justify additional corrective osteotomy procedures.