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Coronal Plane Screening of Lower Limb Deformity

Article  in  Malaysian Orthopaedic Journal · July 2022

DOI: 10.5704/MOJ.2207.024

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Ren Yi Kow Nazri Mohd Yusof

International Islamic University Malaysia International Islamic University Malaysia
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Chooi Leng Low

Sultan Ahmad Shah Medical Centre @IIUM
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Malaysian Orthopaedic Journal 2022 Vol 16 No 2 Kow RY, et al

doi: https://doi.org/10.5704/MOJ.2207.024

LETTER TO THE EDITOR

Coronal Plane Screening of Lower Limb Deformity

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited

Date of submission: 24th February 2021

Date of acceptance: 12th July 2021

Dear editor, site1,2. Nevertheless, this technique is relatively difficult to

Lower limb deformity is defined as deviation of the normal
alignment or orientation of the affected limb1,2. Pre-operative
planning for deformity correction involves identification of
the cause of deformity, be it from the bone (femur or tibia),
the joint (hip, knee or ankle) or both the bone and joint
involvement. Nowadays, malalignment and malorientation
test, described by Paley et al, is routinely being used in pre-
operative planning to delineate and identify the pathological
comprehend especially by inexperienced personnel. This is
due to multiple seemingly identical measurements such as
lateral proximal femur angle (LPFA), mechanical lateral
distal femur angle (mLDFA), anatomical lateral distal femur
angle (aLDFA), medial proximal tibial ankle (MPTA), and
lateral distal tibial ankle (LDTA), with all ranging from 81°
to 90°. We propose an easier screening method to identify the
site of deformity of the lower limb.

(a) (b) (c) (d)

Fig. 1: (a) Mechanical axis is drawn from the center of femoral head to the midpoint of the ankle. (b) Anatomical axis is drawn for both
femur and tibia by connecting the midpoint of the medullary canal. (c, d) Modified joint line convergence angle (mJLCA) is
measured by comparing four imaginary lines. The four lines include a line from the center of femoral head to the proximal part
of greater tuberosity, distal femur joint line, proximal tibia joint line and ankle joint line.

Author: Ren Yi Kow, Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, Jalan Sultan Ahmad Shah,
25200 Kuantan, Pahang, Malaysia
Email: renyi_kow@hotmail.com

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Malaysian Orthopaedic Journal 2022 Vol 16 No 2 Kow RY, et al

(a) (b) (c) (d) (e)

Fig. 2: (a) Normal mechanical axis, normal anatomical axis for both tibia and femur with parallel mJLCA (all four imaginary lines are
parallel to each other). In this case, the femur, tibia and joint are all normal, provided there is no shortening compared to the
contralateral leg. (b) Normal mechanical axis but abnormal anatomical axis of either femur or tibia bone. The mJLCA may be
normal. This indicates femur or tibia compensated deformity. (c) Abnormal mechanical axis, normal anatomical axis for both
tibia and femur with disrupted mJLCA. This indicates deviated mechanical axis secondary to joint pathology. (d) Abnormal
mechanical axis, abnormal anatomical axis of either femur or tibia bone with normal mJLCA. In this case, the pathological bone
is causing the mechanical axis deviation. (e) The mechanical axis deviation and disrupted modified joint line convergence angle
(mJLCA) is due to the tibial deformity.

There are three components in this screening technique,
namely the mechanical axis, anatomical axis and the
modified joint line convergence angle (Fig. 1). First,
mechanical axis is drawn from the centre of femoral head to
the midpoint of the ankle. Next, anatomical axis is drawn for
both femur and tibia by connecting the midpoint of the
medullary canal. Finally, the modified joint line convergence
angle (mJLCA) is measured by comparing four imaginary
lines. The four lines include a line from the centre of femoral
head to the proximal part of greater tuberosity, distal femur
joint line, proximal tibia joint line and ankle joint line. All
four lines should be parallel to each other. Any deviation of
more than 3° indicates articular deformity.
There will be four potential outcomes in this screening
technique:
1. Normal mechanical axis, normal anatomical axis for both
tibia and femur with parallel mJLCA (all four imaginary
lines are parallel to each other). In this case, the femur,
tibia and joint are all normal, provided there is no
shortening compared to the contralateral leg (shortening
indicates sagittal deformity in the absence of coronal
deformity) (Fig. 2a)
2. Normal mechanical axis but abnormal anatomical axis of
either femur or tibia bone. The mJLCA may be normal.
This indicates femur or tibia compensated deformity
(Fig. 2b).
3. Abnormal mechanical axis, normal anatomical axis for
both tibia and femur with disrupted mJLCA. This
indicates deviated mechanical axis secondary to joint
pathology (Fig. 2c).
4. Abnormal mechanical axis, abnormal anatomical axis of
either femur or tibia bone with normal mJLCA. In this
case, the pathological bone is causing the mechanical
axis deviation (Fig. 2d and e).
By using this simple screening method, one can easily and
swiftly locate any lower limb bone or joint pathology with
only seven straight lines (mechanical axis, femur anatomical
axis, tibia anatomical axis, and four parallel joint lines as
mentioned above).
Kow RY1, MS Orth
Low CL2, MBBS
Yusof MN1, MMed Orth
1
Department of Orthopaedics, Traumatology and
Rehabilitation, International Islamic University Malaysia,
Kuantan, Malaysia
2
Department of Radiology, Sultan Ahmad Shah Medical
Centre @IIUM, Kuantan, Malaysia

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Coronal Plane Screening

REFERENCES Cite this article:

Kow RY, Low CL, Yusof MN. Coronal Plane Screening of
1. Paley D, Herzenberg JE, Tetworth K, McKie J, Bhave A.
Lower Limb Deformity. Malays Orthop J. 2022; 16(2): 159-61.
Deformity planning for frontal and sagittal plane corrective
doi: 10.5704/MOJ.2207.024
osteotomies. Orthop Clin North Am. 1994; 25(3): 425-65.
2. Paley D, Tetworth K. Mechanical axis deviation of the
lower limbs. Preoperative planning of uniapical angular
deformities of the tibia or femur. Clin Orthop Relat Res.
1992; (280): 48-64.

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