University of Utah, Salt Lake City, UT 84108, USA.
Foot Ankle Int. 2012 Aug;33(8):655-61. doi: 10.3113/FAI.2012.0655.
The medial distal tibial angle (MDTA) is used to determine ankle alignment. The mortise view is the standard to measure MDTA, but the hindfoot alignment view (HAV) has become popular. The MDTA may vary between views, influencing the choice of surgery.
The MDTA was compared between the mortise and HAV in 146 ankles. MDTA was correlated to age and sagittal tibial tilt for each view. Differences in MDTA by gender and ethnicity were assessed. Diagnostic agreement (varus, valgus, normal) between views was calculated. Clinical assessment of alignment was determined and percent agreement between clinical and radiographic alignment was quantified.
The MDTA measured from the mortise view and HAV radiographs was 89.0 (range, 81 to 96 degrees; SD = 2.8) degrees and 86.0 (range, 73 to 95 degrees; SD = 3.5) degrees, respectively. The MDTA was comparable for both genders for mortise (p = 0.356) and HAV (p = 0.621). The MDTA was comparable in all ethnic groups for mortise view (p = 0.616) and HAV (p = 0.916). Correlation between the measured MDTA and age was not statistically significant for both the mortise (r = 0.118; p = 0.158) and HAV (r = 0.148; p = 0.074). In only 47.3% of all ankles was the radiographic diagnosis of alignment the same between views. Agreement between clinical and radiographic classifications was 60.3% for the mortise view and 52.8% for the HAV.
Substantial disagreement in primary alignment was found between the mortise and HAV as quantified by the MDTA. Agreement between clinical and radiographic alignment was also poor.
Advanced imaging such as CT or MRI may better describe ankle alignment.
内踝远端胫骨角（MDTA）用于确定踝关节对线。正位片是测量 MDTA 的标准视图，但跟骨侧位片（HAV）已变得流行。MDTA 在不同视图之间可能存在差异，影响手术选择。
比较 146 例踝关节正位片和 HAV 片的 MDTA。比较各视图的 MDTA 与年龄和胫骨矢状倾斜角的相关性。评估性别和种族对 MDTA 的影响。计算两种视图下的诊断一致性（内翻、外翻、正常）。评估临床对线评估，并量化临床与放射对线之间的一致性百分比。
正位片和 HAV 片测量的 MDTA 分别为 89.0（范围，81 至 96 度；标准差=2.8）度和 86.0（范围，73 至 95 度；标准差=3.5）度。正位片和 HAV 片中 MDTA 在两性之间相似（p=0.356）。在所有种族群体中，正位片和 HAV 片中 MDTA 相似（p=0.616）。正位片（r=0.118；p=0.158）和 HAV（r=0.148；p=0.074）中测量的 MDTA 与年龄之间的相关性均无统计学意义。在所有踝关节中，只有 47.3%的踝关节在两种视图下的对线诊断相同。正位片的临床和放射分类之间的一致性为 60.3%，HAV 为 52.8%。
MDTA 量化发现，正位片和 HAV 之间的初始对线存在显著差异。临床和放射对线之间的一致性也较差。
高级影像学检查（如 CT 或 MRI）可能更好地描述踝关节对线。
