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Background: A coherent measurement approach for sagittal alignment of the distal femur after fracture reduction or distal femur osteotomies is not available. The present study aims to introduce a new method using Blumensaat's line and tangent lines to the femoral cortexes to determine the sagittal alignment of the distal femur. Methods: 113 patients who had true lateral knee radiographs were included. All of the radiographs were evaluated by one fellowship-trained knee surgeon and one radiologist using the PACS system. The Blumensaat's line was determined on the true lateral knee radiographs. Then, three long lines were drawn on the distal third of the femoral shaft. The first line is tangent to the anterior cortex of the femur, the second line is along with the anatomical axis of the femur, and the third line is tangent to the posterior cortex of the femur. The angles between Blumensaat's line and these lines were measured. Intraclass Correlation Coefficient (ICC) was used to measure the strength of inter-and intra-rater agreement. Results: The mean angle between the Blumensaat's line and the anatomical axis of the femur was 35.4 ± 3°. The mean angle between the Blumensaat's line and the line tangent to the anterior femoral cortex and the line tangent to the posterior femoral cortex were 34.5 ± 3° and 35.2 ± 3°, respectively. Excellent inter-and intra-rater reliabilities were observed between the measurements (ICC = 0.96 and ICC = 0.98, respectively). The angle between the Blumensaat's line and the line tangent to the posterior femoral cortex was significantly higher in participants aged < 38 years (p = 0.049). No other significant association was found between the angles and demographic characteristics of the patients. Conclusions: The expected mean angles between the Blumensaat's line and the distal femur were 34.3 to 35.4 degrees. This finding could be useful to determine the normal sagittal alignment of the distal femur. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Objective Knee osteoarthritis is one of the most common musculoskeletal disorders affecting balance. It is also a risk factor for falling in older people. People with a history of falling, whether being injured or not, acquire a fear of potential falling, so they limit their functional activities, leading to decreased mobility, muscle weakness, and increased risk of falling in the future. Evaluating the relationship between balance and fear of falling in these patients can detect the disability mechanisms and falling and also help find more effective therapeutic methods for these patients. Some previous studies evaluated the stability of patients by clinical methods in static situations and related it to fear of falling. However, the walking stability of patients was not assessed by laboratory-based systems in previous studies. Therefore, we aimed to evaluate dynamic (during walking and based on the center of mass sways) and static stability (based on the center of pressure sways) and their relationship with falling risk in patients with knee osteoarthritis. Materials & Methods This is a descriptive cross-sectional study. A group of 15 subjects with mild to moderate knee osteoarthritis with a Mean±SD age of 50±3.22 years and 15 normal subjects with comparable age, height, and weight participated in this study. The subjects' standing stability was evaluated using a Kistler force plate based on mediolateral (ML) and anteroposterior (AP) displacements of the center of pressure. Also, the dynamic stability of the subjects was evaluated during walking and based on the center of massbase of support relationship in AP and ML directions. Kinematic data were collected using a motion analysis system with 7 high-speed cameras and a Kistler force plate. To model the body segments, the output of Qualisys track manager software was exported to Visual 3D software. Fear of falling was assessed by the native version of the fall efficacy scale (FES-I). The normal distribution of data was checked by the Shapiro-Wilk test. The independent samples t-test was used to compare the stability of patients and normal subjects. The Pearson correlation coefficient was used to evaluate the relationships between static and dynamic stability parameters and fear of falling in patients with knee osteoarthritis. Results Patients with knee osteoarthritis had less stability during standing and walking than healthy subjects (P<0.05). Moreover, based on the results of this study, there was a linear relationship between the center of body pressure (COP) excursions in the AP direction and the fear of falling scale. Still, it was not significant (r=0.416, P=0.123), and there was no correlation between the other COP parameters with FES (r=0, P>0.05). The correlations between mean center of mass (COM) excursion in AP and ML directions and FES were 0.309 and -0.123, respectively; however, these correlations were also not statistically significant (P>0.05). Conclusion Based on the results of this study, there is no significant relationship between static and dynamic stability of the patients with mild to moderate knee osteoarthritis (based on COP-COM variables) and the fall efficiency scale. So, it seems that to improve these patients' functional abilities, and the therapists must focus on the other parameters that affect the falling, such as reducing pain, improving proprioception, and enhancing muscle strength. It is suggested that future studies include a more varied age range of elderly people and evaluate all contributing factors in falling of patients with knee osteoarthritis (such as pain, proprioception, vision, and muscle strength) and also evaluate the stability of patients with both laboratory-based and clinical tests. [ABSTRACT FROM AUTHOR]