Original Article

Correction of Multiplanar Proximal Tibial Deformities Using the Taylor

Spatial Frame

Abstract Ahmed Mohamed

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Context: The management of multiapical and multidirectional deformities of the proximal tibia Abdelaziz,
is still a challenging task with acute correction. The Taylor spatial frame (TSF) enables gradual Hosny A. Gamal1,
correction in all planes. Aims: The study investigated the accuracy of correction for multiplanar
proximal tibial deformities which had performed with the preassembled TSF. The complications Allam S. Ahmad1,
and functional outcome were investigated. Settings and Design: Retrospectively, we compared Abdulalim A.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 08/27/2023

the parameters of proximal tibial angles before and after using the preassembled TSF frame Abdulsalam1
technique for correction. We used the mechanical axis deviation (MAD), medial proximal tibial Department of Orthopedic,
angle (MPTA), posterior proximal tibial angle (PPTA), and tibial rotation as reference parameters Al-Razi Orthopedic Hospital,
for accuracy judgment. The deformities were divided into three main planes, each plane subdivided Ministry of Health, Kuwait,
by two directions of angulations. Subjects and Methods: The study included 15 patients (20
1
Department of Orthopedic,
tibiae), who underwent a tibial osteotomy surgery after obtaining informed consent for deformity Faculty of Medicine, Benha
University, Egypt
correction using the TSF (Smith and Nephew, Memphis, TN, USA) between June 2016 and May
2018. Results: The three‑plane deformities experienced an accurate correction of MAD. MPTA and
PPTA were accurately corrected in patients with coronal and sagittal plane deformities, respectively.
Rotational deformities were corrected to a satisfactory degree of accuracy in all cases. TSF correction
for multiplanar proximal tibial deformities achieved an excellent result regarding functional outcome.
Conclusions: Gradual correction for multiplanar proximal tibial deformities with the TSF is accurate,
simple and with few complications.

Keywords: Gradual correction, Taylor spatial frame, tibial deformities

Introduction Our study aimed to investigate the concept

The proximal tibial deformities alter the
proper transmission of forces across the
knee joint. Even moderate malalignment
5° reportedly initiates or facilitates the
progression of osteoarthritis.[1]
The management of multiapical and
multidirectional deformities of the lower
limb is still a challenging task with acute
correction.[2,3]
In the last decades, external fixators,
especially the circular Ilizarov fixator,
have become popular to correct complex
deformities.[4]
The Taylor spatial frame (TSF) (Smith
and Nephew) was introduced in 1994 and
became popular in the following years.
It is a modular circular external fixation
system using the same methods of frame
of correction for multiplanar proximal tibial
deformities which had performed with the TSF.
Subjects and Methods
This study included 15 patients (20 tibiae)
who underwent a tibial osteotomy surgery Submitted: 26-Feb-2020
after obtaining informed consent for Revised: 23-Mar-2020
deformity correction using the TSF (Smith Accepted: 30-Mar-2020
and Nephew, Memphis, TN, USA) Published: 30-Jun-2020
between June 2016 and May 2018. There
were 9 females and 6 males with an
average age of 21.5 (range, 10–33 years). Address for correspondence:
Dr. Ahmed Mohamed Abdelaziz,
Five (3 females and 2 males) of the Ministry of Health, Al‑Razi
15 patients had bilateral corrections. Orthopedic Hospital, P.O. Box:
4235 Safat Code 13043, Kuwait.
Our indication for the use of the TSF for E‑mail: ahmed_abdelaziz50@
proximal tibial deformities was multiplanar yahoo.com
deformity consisting of coronal plane
deformity of a magnitude >10°, sagittal
plane deformity, or presence of rotational Access this article online

attachment and the same gradual correction deformity. Patients with nonunion, patients Website:
principles as the Ilizarov device.[5] who primarily underwent tibial lengthening, www.jlimblengthrecon.org

and patients who underwent deformity DOI: 10.4103/jllr.jllr_5_20

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correction with a different method Quick Response Code:
than the TSF were all excluded. The
How to cite this article: Abdelaziz AM, Gamal HA,
Ahmad AS, Abdulsalam AA. Correction of multiplanar
proximal tibial deformities using the taylor spatial
frame. J Limb Lengthen Reconstr 2020;6:40-7.

40 © 2020 Journal of Limb Lengthening & Reconstruction | Published by Wolters Kluwer - Medknow
 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF
contraindications for using TSF were elderly patients who
have no ability to care for themselves and patients who
have a severe or uncontrolled psychiatric disease.
Clinical preoperative evaluation was carried out including
history and physical examination. Frontal and sagittal plane
deformities on long lower‑limb standing radiograph were
analyzed. Limb length discrepancy (LLD), mechanical
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axis deviation (MAD), and joint orientation angles
that are lateral distal femoral angle, medial proximal
tibial angle (MPTA), lateral distal tibial angle (LDTA),
posterior distal femoral angle, and posterior proximal tibial
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angle (PPTA) were measured using the methods described
by Paley [Figure 1].[6,7]
Assessment of tibial rotation was done clinically by
measuring the thigh–foot axis (TFA) in prone position
and measuring the angle between patella up axis and heel
bisector axis in supine position.[8]
Each tibial deformity was analyzed with six axes: coronal
plane angulation (varus or valgus) and translation (medial
or lateral), sagittal plane angulation (procurvatum or
recurvatum) and translation (anterior or posterior), and axial
plane angulation (internal or external) and translation (short
or long).[9]
Preassembled TSF was built preoperatively with chronic
mode after inputting the deformity and preliminary
a b
Figure 1: Long lower‑limb standing radiograph with joint orientation
angles: (a) Coronal view for varus deformity shows mechanical axis
deviation, lateral distal femoral angle, medial proximal tibial angle <85°,
and lateral distal tibial angle. (b) Sagittal view for recurvatum deformity
shows posterior distal femoral angle and posterior proximal tibial angle >84°
Journal of Limb Lengthening & Reconstruction | Volume 6 | Issue 1 | January‑June 2020
mounting parameters into the TSF web‑based
software (www.spatialframe.com) computer program,
the strut lengths were determined by the computer, and
the frame was constructed in a manner replicating the
deformity.[5] Preassembled frame technique was used
to reduce the time of the surgery and adjust the distance
between the rings preoperatively, which had led to reduce
the number of strut changes postoperatively during
correction phase.
Patients underwent surgery on the next day of
admission. All surgeries were performed under general
anesthesia. Patients were administered prophylactic
antibiotic with anesthesia induction. Tourniquet was
not used during the procedure. Common peroneal
nerve release was done for valgus, rotational
deformities, and tibial lengthening cases.[10,11,12] Fibular
osteotomy was performed in all cases. At times, we
resected a small section of the fibula if substantial
fibular shortening or early fibular consolidation was
anticipated. TSF frame had been attached to the bone
using one tensioned wire as a reference wire for
proximal ring beside three perpendicular coated half
pins with hydroxyapatite (HA) (Orthofix, Verona,
Italy) [Figure 2a and b]. For distal ring, three HA‑coated
half pins in different planes were used for fixation.[13] We
used a 2/3 ring proximally to accommodate posterior leg
swelling and allow knee flexion.
The osteotomy for the tibia was performed with multiple
drill holes and completed with osteotome but left
nondisplaced [Figure 2c]. Final mounting parameters were
calculated after the placement of the TSF.
After the surgery, patients were allowed to bear weight as
tolerated, and range‑of‑motion exercises for the knee and
ankle were encouraged. A daily shower, including washing
the pin sites with antibacterial soap, was encouraged
1 week postoperatively. This was followed by pin care
with chlorhexidine 0.5% in water and then wrapped with
sterile gauze soaked with chlorhexidine 0.5% in water or
povidone‑iodine 10%.[14]
We entered deformity parameters into web‑based software
and generated an adjustment schedule postoperatively
with total residual operating mode. The program required
input of deformity, frame, and mounting parameters,
in addition to structures at risk to determine the rate of
correction. Deformity correction commenced 5–7 days
after the surgery. Patients were discharged mobilizing
weight‑bearing as tolerated with crutches and instructed to
perform gradual adjustments for the six struts of the TSF
according to the adjusting schedule three times/day, two
struts per each session. Radiographs were taken at 2 weeks
to be certain that the osteotomy was moved.
Patients were seen in the clinic every week during the
distraction phase. Once the alignment was corrected and
41
 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF
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a b
Figure 2: Taylor spatial frame proximal ring attachments: (a) Ilizarov wire insertion from lateral to medial side under fluoroscopy guide and check the
wire is perpendicular to the proximal tibial mechanical axis. (b) Two half pins placed anteromedial and anterolateral under image guide and directed
posterolateral and posteromedial to be perpendicular to each other. (c) Osteotomy is complete under fluoroscopy
the adjustments ended, patients were seen monthly until
frame removal. At the end of the schedules, the limb
alignment was determined with physical examination and
radiograph. On long lower‑limb standing radiograph, we
measured MAD, MPTA, PPTA, and LLD using the same
methods used before the surgery, and we assessed the
rotation by patella up test and TFA. When there was a
residual deformity, we generated and implemented another
correction schedule.
Our criteria for frame removal were the ability to walk
with minimal assistance with no pain at the osteotomy site
and the presence of bridging callus on three of four cortices
using the anteroposterior, internal oblique, external oblique,
and lateral radiographs.[1,15]
For all patients, we recorded the number of schedules
needed, adjusting weeks, total wearing period of the
frame, complications, knee and ankle range of motion, and
follow‑up in months postframe removal.
Deformity parameters, including degree of varus
(16 tibias – 2 tibias with medial compartment osteoarthritis)
or valgus (2 tibias), procurvatum (8 tibias) or recurvatum
(2 tibias), and internal (15 Tibias) or external rotation
(4 tibias) deformities, were recorded [Table 1]. This
illustrated the magnitude and nature of the preoperative
deformity.
We analyzed the outcomes of MPTA, PPTA, and TFA
beside computed tomographic rotational profile in isolated
rotational deformity, relative to preoperative measurement.
MAD was analyzed according to the planned treatment goal.
[Supplementary Material 1].
The aims of the analysis were to confirm a clinically
important improvement in certain measurements and
its accuracy postoperatively at an average of 11 (range,
6–24 months) of follow‑up.
As the TSF follows the same principals of callus distraction
such as Ilizarov technique, we have followed the scoring
system of the Association for the Study and Application of
42 Journal of Limb Lengthening & Reconstruction | Volume 6 | Issue 1 | January‑June 2020
c
the Methods of Ilizarov (ASAMI) for evaluation of bony
and functional results of the study.[16]
Results
The software SPSS for Windows Release 10 (SPSS Inc.,
Chicago, IL, USA) was used for all statistical calculations.
Each variable was tested for its normal value using the
Kolmogorov–Smirnov test. Significance was set at the
P < 0.05 level.
The MAD was postoperatively divided into three results:
1. MAD center within 5 mm medial or lateral[1,10]
2. MAD overcorrection to 6–12 mm medial or lateral
depending on the presenting problem in the patients
who had unicompartmental arthritis[1,11]
3. MAD improvement with femoral origin residual deformity.
For patients with tibial origin varus deformity (11 patients),
MAD was central with a range of 5 mm medial and 5 mm
lateral to midline, and for the patient with tibial and
femoral origin varus deformity (one patient), MAD was
central with 2 mm medial to midline [Table 2].
In two patients with tibial and femoral origin varus
deformity, MAD was overcorrected with a range of 6 mm
to 11 mm lateral to the midline [Table 2].
In two patients with tibial and femoral origin varus
deformity, MAD was improved with a range of 17 mm to
58 mm lateral to the midline [Table 2].
For one patient with valgus deformity due to tibial origin,
MAD was central with 0 mm medial to midline, and for
one patient with tibial and femoral origins, MAD was
central with 5 mm medial to midline [Table 2].
The corrections of MPTA were accurate, and the MPTA
improved from varus or valgus angle to normal orientation
angle in patients with a varus or valgus deformity [Table 1].
Sagittal deformities (procurvatum or recurvatum) [Table 1]
and axial plane deformities (internal or external rotation)
[Table 1] were corrected to a satisfactory degree in all cases.
 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF

Table 1: Six proximal tibial deformities, number of the cases for each deformity and degree range for the entire
cohort, medial proximal tibial angle, posterior proximal tibial angle, thigh foot axis, and postoperative degrees with
P value
Plane of deformity Tibial deformity Number of cases* Preoperative Postoperative P
Coronal Varus 16 MPTA <85° 73 (52‑82) 89.5 (87‑92) 0.002
Valgus 2 MPTA >90° 96.5 (96‑97) 89.5 (89‑90) 0.001
Sagittal Procurvatum 8 PPTA <77° 70.7 (67‑75) 81.6 (80‑83) 0.001
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Recurvatum 2 PPTA >84° 97.5 (91‑104) 83 0.002

Axial Internal rotation 15 TFA ≤0° −12.6 (−28‑0) 10 0.004
External rotation 4 TFA >10° +33 (+24‑+45) 10 0.002
Ranges shown in parentheses. *The cases with combined deformities, counted for each type of deformity. MPTA: Medial proximal tibial
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angle, PPTA: Posterior proximal tibial angle, TFA: Thigh foot axis

Table 2: Preoperative versus postoperative mechanical axis deviation (mm) with P value
Preoperative Preoperative MAD Postoperative goal
deformity Central Overcorrection Improvement
medial lateral medial lateral medial lateral
MAD medial Tibial origin (11 patients) 48 (24‑95) 0.8 (0‑5) 3.8 (3‑5)
(varus) P 0.001 0.01
Tibial and femoral origin (one patient) 104 2
Tibial and femoral origin (2 patients) 102.5 (100‑105) 8.5 (6‑11)
P 0.03
Tibial and femoral origin (2 patients) 61 (78‑44) 37.5 (17‑58)
P 0.002
MAD lateral Tibial origin (one patient) 28 0
(valgus) P 0.001
Tibial and femoral origin (one patient) 60 5
P 0.02
Ranges shown in parentheses. MAD: Mechanical axis deviation

Statistical analysis for all proximal tibial angles and MAD
showed a significant improvement with P < 0.05 using the
Kolmogorov–Smirnov test.
Patients had web‑based schedules for correction with an
average of 2.8 (range, 1–5 schedules), which last on average
5.9 (range, 2–10 weeks), and the total period of wearing
the frame averaged 18.9 (range, 12–26 weeks). Although
these patients group included only those with deformities,
there was associated LLD in some patients; this explained
the long distraction time and period of wearing the frame
for some patients.
We recorded all the complications occurred with using TSF
during this study, there were ten patients had complication:
six cases (30%) related to wire infection that improved
with wire removal in the clinic, one case (5%) had pin site
infection that required removal in the operating room, and
one case (5%) had cellulitis that required a 10‑day course
of intravenous antibiotics. Two cases (10%) had reported
osteotomy site pain in the 1st day postoperatively who
improved with early compression software program. All
the cases (100%) developed pin site reaction during the
adjusting or consolidation periods for one or more of the
half pins, which was considered as a minor complication
because it resolved with daily dressing.
Preassembled frame technique was used to reduce the time
of the theater and optimized a strut exchange which was
potentially cheaper and more accurate.
There were no cases of joint stiffness, compartment
syndrome, deep vein thrombosis, nerve palsy, reflex
sympathetic dystrophy, delayed union and nonunion,
premature consolidation, hardware failure, or residual
deformity.
According to the ASAMI scoring system, the results of
the study showed that bony results were excellent in
13 cases (65%), good in 7 cases (35%), and no fair or poor
bony results were seen in our study. Functional results were
excellent in 20 cases (100%). Good, fair, poor, and failure
functional results were not recorded for any patient of our
study [Table 3].
Discussion
Although deformity correction of the proximal tibia can
often be accomplished with an acute correction and the
use of internal fixation, this method has limitations.[1‑3] The
presence of multiplanar deformities, symptomatic LLD,
and lack of postoperative adjustability show the limitations
of this method. Acute correction of a proximal tibial
osteotomy can be associated with significant complications:

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 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF

Table 3: Association for the Study and Application of the TSF is able to correct six‑axis deformities
Methods of Ilizarov score descriptions for bony result simultaneously with computer accuracy. Therefore,
and functional result after the application of the frame the surgeon is needed
Number of the cases Percentage to perform accurate deformity analysis and input all
Bony results the parameters to the website program. Undoubtedly,
Excellent 13 65 hexapod systems have become the treatment of choice
Good 7 35 for multiplanar skeletal deformities, especially with
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Fair Nil 0 rotational components. [5]

Poor Nil 0 Our study concept aimed to investigate the accuracy of
Functional results correction for multiplanar proximal tibial deformities which
Excellent 20 100 had performed with the TSF. We carefully reviewed the
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Good Nil 0 literature over the last years and found there is general
Fair Nil 0 consensus that the TSF is a very efficient surgical tool
Poor Nil 0
Failure Nil 0 [Table 4].[15,21-30]
common peroneal nerve palsy and compartment syndrome;
the rate of neurovascular complications had reported to
range from 3.3% to 18%.[17,18]
The Ilizarov method of deformity correction and limb
lengthening was the most important contribution in
the field of deformity correction in the last century.[4]
Significant disadvantages of the Ilizarov frame include a
long learning curve and the need for frame adjustments
with creation of additional hinges when correcting
multiplanar deformities. When using the Ilizarov ring
fixator (IRF) and its hinge system, it may sometimes
become difficult or even impossible to place the hinges
in the desired position, due to the frame construct
itself. Even though the construct of the Ilizarov device
theoretically may allow for axial corrections in every
possible dimension, the treatment of multidimensional
deformities may practically only partially be possible
and mostly affords a step‑by‑step treatment of all
deformities. This may lengthen the procedure and is
prone to lead to further deformities. Furthermore, the
correction of rotational deformities with the Ilizarov
frame is a challenging task even for the most experienced
surgeons.[6,19]
The greatest advantage of the TSF and other hexapod
systems is the elimination of the need for frame
adjustments because they use six struts of adjustable length
attached to universal hinges to move an object in six
degrees of freedom. Spatial fixators are based on identical
biological properties and host response as those of a
traditional Ilizarov fixator, with possibly better mechanical
properties and ease of use.[20] With the introduction of
hexagonal strut geometry, the precise displacement of the
proximal and distal fragments relative to each other is
achieved. However, this improvement comes with a price
of increased cost. Spatial fixator costs are six to ten times
higher than traditional Ilizarov circular external fixators.
For this reason, it is essential to identify patients for which
spatial fixators would play a significantly effective role.
that allows the correction of any kind of deformity
Rodl et al. investigated the workspace of a standard IRF
construct compared to a standard TSF construct. According
to the results of this experimental study, the TSF provides
advantages in the correction of rotational and translational
deformities.[31]
Seide et al. reported on 16 cases treated with the Hexapod
Ilizarov Fixator (LITOS GmbH & CO KG, Hamburg,
Germany), and stressed the easy use of this fixator
compared to the IRF when dealing with multidimensional
deformity corrections. They found it favorable to use the
hexapod to avoid difficult and time‑consuming alterations
of the IRF construct, as sometimes necessary when dealing
with rotational deformities and secondary deformities
during the lengthening procedure.[32]
Manner et al. concluded that the TSF allowed for much
higher precision in deformity correction compared to the
IRF. In multidimensional deformity corrections in particular,
the TSF showed clear advantages. This may derive from
the TSF‑specific combination of a hexapod fixator with the
support of an Internet‑based software program, enabling
precise simultaneous multiplanar deformity corrections.[33]
We investigated the correction for all planes with TSF
simultaneous without many frame adjustments using
preassembled frame technique and checked the rate of
complications. We did not compare our result with a
similar cohort of patients treated by classic Ilizarov frame,
as our center depends on hexapod frame for the treatment
of multiplanar proximal tibial deformities.
There were statistical significance accurate
improvements between preoperative and postoperative
parameters with using TSF. The patients in our study
were very satisfied with the functional outcome, as
indicated by the ASAMI score. All the patients indicated
that they would undergo the same procedure. The
overall clinical results suggest that patients’ satisfaction
was high with this procedure as long as there were no
major complications. We agree that ours is not a very
novel concept and that many authors have shown good

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 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF

Table 4: Literature summary on Taylor spatial frame for deformity correction

Study Population Design Anatomic region Deformity correction Conclusions regarding TSF
Eidelman 30 children and Retrospective Mixed bones 30/31 anatomically corrected Accurate fixator for
et al.[21] adolescents deformity correction
Feldman 18 adults Retrospective Tibia 17/18 achieved significant deformity Effective technique for
et al.[22] 11 malunions correction and union deformity correction
7 nonunions
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Feldman 19 children and Retrospective Tibia vara 21/22 corrected to within 3° Accurate and safe correction
et al.[23] adolescents (22 (proximal)
tibias)
Feldman 18 children and Retrospective Tibia vara MAD was 3.1 mm in gradual Gradual correction with TSF
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et al.[24] adolescents comparison of (proximal) correction group compared with is more accurate than acute
Gradual correction 17.1 mm in acute correction group. correction
using TSF (18) with MPTA within 38 of normal in 17/18
acute correction (14)
Naqui 53 children and Retrospective Tibia (44) 52/55 limbs ended with <15 mm Effective and efficient way
et al.[25] adolescents (55 Femur (11) LLD and 5° angular deformity to correct a wide variety
limbs) of simple and complex
deformities
Nho Case report Tibia Intentional deformity was TSF can be used in
et al.[26] temporarily implemented to a versatile fashion to
facilitate wound healing. Deformity temporarily create and then
correction, lengthening, and union correct tibial deformity
subsequently were achieved
Siapkara 3 adolescents Case series Proximal tibia PPTA and coronal plane deformity TSF was used successfully
et al.[27] with anterior were corrected to normal. LLD was to correct deformity and
growth arrest corrected LLD
and recurvatum
deformity
Tellisi 2 adults with Case series Proximal tibia One patient with varus and TSF can be used to correct
et al.[28] congenital limb shortening had correction to neutral
deformity and lengthen a
deficiencies and lengthening; the second patient
residual limb to improve
with valgus had correction to neutral
prosthesis fit and function
Tsaridis One patient with Case report Proximal tibia Severe tibial deformity was TSF used to correct
et al.[29] Paget’s disease corrected before a staged TKA deformity in Paget’s disease
Watanabe One patient with Case report Proximal tibia Deformity was corrected TSF successfully used for
et al.[30] failed opening revision HTO after failed
wedge HTO opening wedge correction
Rozbruch 102 adults Retrospective Tibia all zones MAD was 3 mm lateral to 8 mm Gradual correction with TSF
et al.[15] and children medial after neutral correction; after of all tibial deformities is
(122 tibia) intentional overcorrection, MAD safe and precise
with complex was 8 mm lateral to 12 mm medial.
deformities MPTA improved to 85°‑ 89°. LDTA
improved to 86°‑89°; 15/17 had less
than 5° diaphyseal deformity
TSF: Taylor spatial frame, MAD: Mechanical axis deviation, MPTA: Medial proximal tibial angle, PPTA: Posterior proximal tibial angle,
LLD: Limb length discrepancy, LDTA: Lateral distal tibial angle, TKA: Total knee arthroplasty, HTO: High tibial osteotomy

results in tibial deformity correction as well. We agree when there are multiapical and multidirectional deformities
that a comparison with deformity correction done using or extensive LLD. Our results compare favorably with the
the older Ilizarov fixator would have made the article published literature.
more useful.
Financial support and sponsorship
Conclusion Nil.
Based on our results, we think that the TSF allows gradual
Conflicts of interest
correction with safe, simple, accurate procedure and in
well‑tolerated manner [Figure 3]. This is particularly useful There are no conflicts of interest.

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 Abdelaziz, et al.: Correction of multiplanar proximal tibial deformities using TSF
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a b c
Figure 3: Taylor spatial frame gradual correction of tibial varus deformity
after attempt of acute correction during childhood showed in long
lower‑limb standing radiograph: (a) Right tibial varus deformity with residual
hardware. (b) Taylor spatial frame correction completed. (c) Corrected tibial
varus deformity after Taylor spatial frame had removed
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Journal of Limb Lengthening & Reconstruction | Volume 6 | Issue 1 | January‑June 2020 47

 Supplementary Material 1: TSF deformity parameters for the entire cohort with resultant parameters
Case, sex, and Tibial Preoperative Postoperative
age in years deformity MAD (mm) MPTA (°) PPTA (°) TFA (°) MAD (mm) MPTA (°) PPTA (°) TFA (°)
(1) Male 13 Vr/IR/Re 95 M 63 91 −20 3L 91 83 10
(2) Male 14 Vr/IR 37 M 74 81 −16 0 89 82 10
(3) Female 29 Vr/IR/Pr 66 M 72 75 −16 0 90 82 10
(4) Female 30 Vr/IR 27 M 77 80 −18 0 88 82 10
Downloaded from http://journals.lww.com/jllr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

(5) Female 10 Vr/IR/Pr 54 M 65 70 −20 0 87 81 10

(6) Female 20 Vr/IR 52 M 72 84 −15 5M 87 82 10
(7) Female Vr/IR 56 M 76 82 0 0 90 83 10
(8) Male 22 Vr/Pr 42 M 77 68 10 3L 91 83 10
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 08/27/2023

(9) Male 28 Vr/Pr/IR 45 M 78 71 0 4L 91 80 10

(10) Female 17 Vr/IR/Pr 104 M* 52 74 −16 2M 89 82 10
(11) Male 16 Vl/IR 60 L* 96 82 −10 5M 90 82 10
(12) Male 19 Vl/Re 28 L 97 104 10 0 89 83 10
(13) Female 25 ER/Vr 24 M 82 82 +25 5L 90 82 10
(14) Female 26 ER/Vr 30 M 78 80 +24 4L 90 81 10
(15) Female 21 ER.Sh 8M 86 82 +45 0 89 82 10
CTRP 60 CTRP 25
(16) Female 22 ER.Sh 3M 84 82 +38 0 87 81 10
CTRP 55 CTRP 27
(17) Male 32 Vr/Pr/IR 100 M* 75 67 −7 6L 91 82 10
(18) Male 33 Vr/IR/Pr 105 M* 77 71 −20 11 L 92 81 10
(19) Female 16 Vr/IR/Pr 78 M* 72 70 −28 58 M 89 82 10
(20) Female 16 Vr/IR 44 M* 78 82 −4 17 M 88 82 10
*Tibial and femoral origin. TSF deformity parameters for the entire cohort with resultant parameters, Vr: Varus, Vl: Valgus,
Pr: Procurvatum, Re: Recurvatum, IR: Internal rotation, ER: External rotation, Sh: Short, MAD: Mechanical axis deviation, MPTA: Medial
proximal tibial angle, PPTA: Posterior proximal tibial angle, TFA: Thigh foot axis, CTRP: Computed tomographic rotational profile,
M: Medial, L: Lateral, TSF: Taylor spatial frame