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    Defining sagittal knee phenotypes via monopedal static anterior tibial translation. Part 1: Translating weight bearing sagittal position into clinical risk profiles
    (Wiley, 2026) Kayaalp, Mahmut Enes; Kahraman, Hamit Çağlayan; Erden, Tunay; Lutter, Christoph; Scheffler, Sven; Taşer, Ömer; Becker, Roland; Hirschmann, Michael T.; Dejour, David H.
    Static anterior tibial translation (sATT) is a reproducible monopodal weight‐bearing radiographic parameter that reflects the resting sagittal position of the tibiofemoral joint. Distinct from manual laxity tests that quantify passive displacement limits, sATT captures the functional equilibrium of the tibia under physiological load, representing the cumulative interplay of bony morphology, neuromuscular control, me niscal containment and time‐dependent adaptations. Current literature frequently conflates passive laxity with weight‐bearing sagittal position, leading to an incomplete understanding of why isolated soft‐tissue re constructions fail in biomechanically hostile environments. Elevated sATT manifests in three clinically distinct sagittal phenotypes with specific pathomechanisms: osseous anteriorization primarily related to increased posterior tibial slope and loss of the anterior cruciate liga ment; acquired soft‐tissue anteriorization resulting from sagittal decompensation due to chronic injury and secondary stabilizer, partic ularly meniscal deficiency; and inherent soft‐tissue anteriorization characteristic of generalized hyperlaxity. This paper, Part 1 of a two‐part series, establishes the biomechanical ‘set‐point’ theory, highlights the necessity of strict monopedal imaging to unmask instability and defines how distinct sagittal phenotypes may converge, creating cumulative or synergistic risk patterns that increase the mechanical burden on the central pivot. Level of Evidence: Level V.
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    Defining sagittal knee phenotypes via monopedal static anterior tibial translation. Part 2: The assessment-led personalization (ALP) system for indication and correction target planning in slope-reducing osteotomy
    (Wiley, 2026) Kayaalp, Mahmut Enes; Kahraman, Hamit Çağlayan; Erden, Tunay; Lutter, Christoph; Scheffler, Sven; Taşer, Ömer; Becker, Roland; Hirschmann, Michael T.; Dejour, David H.
    Current decision‐making for slope‐reducing osteotomy (SRO) often relies on isolated posterior tibial slope (PTS) thresholds, potentially misidentifying patients with acquired soft‐tissue decompensation or possibly overtreating those with an asymptomatic, inherently hyperlax baseline. Furthermore, rigid point‐based scoring systems oversimplify the synergistic biomechanics of the anterior cruciate ligament‐deficient knee. Building on the foundational ‘Set‐Point’ theory established in Part 1, this paper introduces the assessment‐led personalization (ALP) system. This unified clinical algo rithm integrates the normalized percentage of absolute static anterior tibial translation (sATT%) and its side‐to‐side difference (ΔsATT%) with PTS la terality, generalized hyperlaxity, and injury chronicity. By mathematically calibrating raw translation data to isolate true soft‐tissue decompensation from underlying osseous asymmetry, the ALP system provides a proactive, joint‐preserving framework to identify high‐risk phenotypes likely to fail isolated soft‐tissue reconstruction and precisely refines the indications for SRO. Level of Evidence: Level V.