Which radiographic plane should be used to quantify the distal tibia angle on weightbearing CT images?

Jules Rasschaert; Pedro Drummond; C&#xe9;dric Bonte; Wolfram Gr&#xfc;n; Enrico Pozzessere; Fran&#xe7;ois Lintz; Cesar de Cesar Netto; Arne Burssens

doi:10.1016/j.fas.2026.04.007

PubMed · 42091367

Which radiographic plane should be used to quantify the distal tibia angle on weightbearing CT images?

Jules Rasschaert·Pedro Drummond·Cédric Bonte·Wolfram Grün·Enrico Pozzessere·François Lintz·Cesar de Cesar Netto·Arne Burssens

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Abstract

BACKGROUND: Precise quantification of distal tibial alignment is essential for planning corrective osteotomies and ankle joint replacement surgery. The lateral distal tibial angle (LDTA) is the principal radiographic parameter used for this purpose. While LDTA is increasingly measured on weightbearing cone-beam CT (WBCT) using two-dimensional coronal slices, the optimal measurement plane remains unclear. METHODS: In this retrospective comparative study, full-leg WBCT scans of patients scheduled for supramalleolar osteotomy (n = 20; mean age 47 ± 12.8 years) were analyzed. LDTA was measured on three coronal planes of the distal tibial plafond (anterior edge, mid-dome, posterior edge) and compared with semi-automated three-dimensional (3D) tibial alignment measurements as the reference standard. RESULTS: Mid-dome LDTA showed no significant difference from the 3D reference (p > 0.05) and demonstrated excellent agreement. Anterior measurements significantly overestimated LDTA, while posterior measurements underestimated it (both p < 0.05), with only fair agreement. CONCLUSION: LDTA should be measured at the mid-dome of the distal tibial plafond on WBCT to ensure accurate and reproducible alignment assessment. LEVEL OF EVIDENCE: Level III - Retrospective Comparative Study.

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Humans Retrospective Studies Tibia Weight-Bearing Middle Aged Cone-Beam Computed Tomography Osteotomy Female Male Imaging, Three-Dimensional Ankle Joint Adult 3D measurement Corrective ankle surgery Distal tibia angle Weightbearing CT Journal Article Comparative Study

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Jules Rasschaert, Pedro Drummond, Cédric Bonte, Wolfram Grün, Enrico Pozzessere, François Lintz, Cesar de Cesar Netto, Arne Burssens. 2026-04-21. Which radiographic plane should be used to quantify the distal tibia angle on weightbearing CT images?. https://doi.org/10.1016/j.fas.2026.04.007

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