Assessing the medial distal tibial angle based on a long ankle view radiograph - Reliability of and differences between three approaches.

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery Pub Date : 2025-02-20 DOI:10.1016/j.fas.2025.02.010

Flavia A Miesch, Werner Vach, Isabella Zbinden, Markus Knupp

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引用次数: 0

Abstract

Background: Lower limb alignment on plain radiographs is commonly examined in orthopedics. Measurement of the medial distal tibial angle (MDTA) requires determining the tibial axis. Traditionally, in orthopedic practice, anatomical or surgical axes have been used. Due to the increasing availability of stitching tools, assessing the mechanical axis of the tibia in a lower leg mortise view radiograph has arisen as a third option. This study evaluated the reliability of three approaches to determine the MDTA on whole lower leg radiographs and the magnitude of the disparities between the approaches.

Methods: Thirty-eight patients were assessed on weightbearing, anteroposterior radiographs. The images included an anterior-posterior image ('mortise view') of the ankle joint, including the entire tibia. The radiographs were captured twice in each patient to analyze the reliability of the technique. The MDTA was measured according to the three approaches by two independent examiners.

Results: The mean absolute difference between MDTAs across two images was 0.8° for the anatomical axis and 0.74° for the mechanical. It was distinctly larger for the surgical axis with 1°. The MDTA differed by more than 2° between the anatomical and mechanical axes in 22 % of the patients and between the mechanical and the surgical axis in 10 % of the patients.

Conclusion: Weightbearing, lower leg mortise view radiographs centered on the proximal tibia and ankle joint provide reproducible values for the MDTA based on the mechanical axis. This approach should be preferred over the anatomical axis in future. The tibial tuberosity should not be used as a reference to determine the MDTA. The choice of the axis can lead to differences in the MDTA of clinically relevant magnitude.

Level of evidence: Level II, Prospective Cohort Study.

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来源期刊

Foot and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.