Sagittal alignment of the lower extremity while standing in Japanese male

There is little information available regarding the sagittal mechanical axis of the lower extremity of normal subjects under weight-bearing conditions. The purpose of this study was to determine the sagittal alignment of the lower extremity under such conditions. Anteroposterior and lateral radiographs were taken of the 20 lower extremities of 10 healthy male Japanese volunteers (mean age, 27 years) while standing. The coronal mechanical axis passed through 33.9% medial to the proximal tibial articulating surface. The sagittal mechanical axis passed through 38.0% anterior to the distal femoral condyle and 27.9% anterior to the proximal tibial articulating surface, and also passed 5.2 mm anterior to the intercondylar notch. Our study therefore showed that the coronal and sagittal mechanical axes of the lower extremity do not always pass through the center of the knee. This has important implications for alignment in surgery of lower extremities such as total knee arthroplasty and osteotomy.