Kim Jaeyoung, Rajan Lavan, Kumar Prashanth, Kim Ji-Beom, Lee Woo-Chun
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Columbia Vagelos College of Physicians and Surgeons, USA.
Foot Ankle Surg. 2023 Jan;29(1):72-78. doi: 10.1016/j.fas.2022.09.008. Epub 2022 Sep 29.
While it is commonly acknowledged that the combined effect of lower limb orientation and ankle and hindfoot alignment play a fundamental role in ankle arthritis, supramalleolar/lower limb alignment has received less attention in valgus ankle arthritis. The purpose of this study was to analyze the lower limb alignment of patients with valgus ankle arthritis with primary origin, compared to that of varus ankle arthritis and normal controls. We hypothesized that patients with valgus ankle arthritis would have the opposite pattern of lower limb alignment as those with varus ankle arthritis.
A retrospective radiographic analysis was performed on 61 patients (62 ankles, mean age, 59.3 ± 12 years) with primary valgus ankle arthritis. On preoperative radiographs, seven parameters, including talar tilt angle, medial distal tibial angle (MDTA), talar center migration, anterior distal tibial angle, talo-first metatarsal (Meary's) angle, hindfoot moment arm (HMA), and mechanical axis deviation (MAD), were measured and compared to those of primary varus ankle arthritis (n = 55; mean age, 59.7 ± 8.1 years) and control patients (n = 59; mean age, 29.3 ± 7.3 years).
The valgus group had a significantly lower mean MDTA than the control group (p < 0.0001), indicating a varus distal tibial plafond in comparison to the control group. Meary's angle and HMA were significantly lower in the valgus group compared to the varus group (p < 0.05 and p < 0.0001, respectively), indicating a lower medial longitudinal arch and valgus hindfoot alignment. On whole limb radiographs, the valgus group showed a greater MAD than the control group, indicating varus lower limb alignment (p < 0.05). However, the MAD did not differ significantly between the valgus and varus groups (p = 0.7031).
Our findings indicate that a significant proportion of ankles with primary valgus arthritis have a varus tibial plafond and a varus lower limb mechanical axis. This study contributes to our understanding of primary valgus ankle arthritis and suggests that lower limb alignment should be analyzed and considered throughout valgus ankle arthritis realignment procedures.
虽然人们普遍认为下肢方位以及踝关节和后足对线的综合作用在踝关节炎中起着根本性作用，但在内翻型踝关节炎中，踝关节上/下肢对线受到的关注较少。本研究的目的是分析原发性外翻型踝关节炎患者与内翻型踝关节炎患者及正常对照组相比的下肢对线情况。我们假设外翻型踝关节炎患者的下肢对线模式与内翻型踝关节炎患者相反。
对61例（62个踝关节，平均年龄59.3±12岁）原发性外翻型踝关节炎患者进行回顾性影像学分析。在术前X线片上，测量包括距骨倾斜角、胫骨远端内侧角（MDTA）、距骨中心移位、胫骨远端前角、距骨-第一跖骨（Meary角）、后足力矩臂（HMA）和机械轴偏移（MAD）在内的七个参数，并与原发性内翻型踝关节炎患者（n = 55；平均年龄59.7±8.1岁）和对照组患者（n = 59；平均年龄29.3±7.3岁）的参数进行比较。
外翻组的平均MDTA显著低于对照组（p < 0.0001），表明与对照组相比胫骨远端关节面呈内翻。与内翻组相比，外翻组的Meary角和HMA显著更低（分别为p < 0.05和p < 0.0001），表明内侧纵弓更低且后足呈外翻对线。在全下肢X线片上，外翻组的MAD大于对照组，表明下肢呈内翻对线（p < 0.
