Radiographic Analysis of Tibial-Articular Surface Angle According to the Selection of the Mechanical Axis

역학적 축 선정에 따른 전후면 경골천장각의 단순방사선학적 분석

  • Park, Jin-Sung (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Jeong, Soon-Taek (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Hwang, Sun-Chul (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Kim, Dong-Hee (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Gwark, Ji-Yong (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Yoon, Hong-Kwon (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine) ;
  • Nam, Dae-Cheol (Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine)
  • 박진성 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 정순택 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 황선철 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 김동희 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 곽지용 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 윤홍권 (경상대학교 의학전문대학원 정형외과학교실) ;
  • 남대철 (경상대학교 의학전문대학원 정형외과학교실)
  • Received : 2013.07.09
  • Accepted : 2013.08.20
  • Published : 2013.09.15

Abstract

Purpose: We investigated a statistical difference of tibial-articular surface (TAS) angles between radiographs of standing ankle anteroposterior (AP) and whole lower extremity view, and evaluated whether the tibial axis obtained from the standing ankle AP view reflects the original mechanical axis of lower extremity. Materials and Methods: Both the standing ankle AP and whole lower extremity view were taken from 60 legs of 30 healthy volunteers without a history of ankle surgery or deformity of lower limb. To determine the tibial axis, Takakura's and Hintermann's method were employed in the standing ankle AP view. To compare these results with the original TAS angle, ANOVA and multiple comparison test were used. Results: The mean TAS angle was 88.3 degrees(from hip joint to ankle), 89.5 degrees (from knee joint to ankle), 88.5 degrees (Takakura's method), and 90.2 degrees(Hintermann's method). Although there was a statistical significance (p=0.000) between these results, Takakura's method had no significant difference, compared to the results of whole extremity view by the multiple comparison test. Conclusion: The tibial axis obtained by Takakura's method reflects the original mechanical axis of lower extremity. When a surgical procedure is planned, however, it is necessary to consider that the ankle radiographs do not provide any information on the proximal deformity without the whole lower extremity view.

Keywords

References

  1. Becker AS, Myerson MS. The indications and technique of supramalleolar osteotomy. Foot Ankle Clin. 2009;14:549-61. https://doi.org/10.1016/j.fcl.2009.06.002
  2. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int. 2003;24:754-64. https://doi.org/10.1177/107110070302401004
  3. Stamatis ED, Myerson MS. Supramalleolar osteotomy: indications and technique. Foot Ankle Clin. 2003;8:317-33. https://doi.org/10.1016/S1083-7515(03)00018-4
  4. Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am. 1998;80:213-8. https://doi.org/10.2106/00004623-199802000-00008
  5. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br. 1995;77:50-4.
  6. Hayashi K, Tanaka Y, Kumai T, Sugimoto K, Takakura Y. Correlation of compensatory alignment of the subtalar joint to the progression of primary osteoarthritis of the ankle. Foot Ankle Int. 2008;29:400-6. https://doi.org/10.3113/FAI.2008.0400
  7. Tanaka Y, Takakura Y, Fujii T, Kumai T, Sugimoto K. Hindfoot alignment of hallux valgus evaluated by a weightbearing subtalar x-ray view. Foot Ankle Int. 1999;20: 640-5. https://doi.org/10.1177/107110079902001005
  8. Stufkens SA, Barg A, Bolliger L, Stucinskas J, Knupp M, Hintermann B. Measurement of the medial distal tibial angle. Foot Ankle Int. 2011;32:288-93. https://doi.org/10.3113/FAI.2011.0288
  9. Inman VT, Stiehl JB. Inman's joints of the ankle. 2nd ed. Baltimore: William & Wilkins; 1991;31-74.
  10. Knupp M, Ledermann H, Magerkurth O, Hinterman B. The surgical tibiotalar angle: a radiologic study. Foot Ankle Int. 2005;26:713-6. https://doi.org/10.1177/107110070502600909
  11. Monji J. [Roentgenological measurement of the shape of the osteoarthritic ankle (author's transl)]. Nihon Seikeigeka Gakkai Zasshi. 1980;54:791-802.
  12. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am. 1987;69:745-9. https://doi.org/10.2106/00004623-198769050-00016
  13. Anderson T, Montgomery F, Carlsson A. Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive ankles. J Bone Joint Surg Am. 2003;85:1321-9. https://doi.org/10.2106/00004623-200307000-00019
  14. Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 2004:57-68.
  15. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br. 2006;88: 909-13. https://doi.org/10.2106/JBJS.E.01398
  16. Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average followup of 65 patients. Clin Orthop Relat Res. 2004:47-56.
  17. Hefti F. Deviations in the axes of the lower extremities. Orthopade. 2000;29:814-20. https://doi.org/10.1007/s001320050531