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Influence of the ankle position and X-ray beam angulation on the projection of the posterior facet of the subtalar joint

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Abstract

Objective

Using digitally reconstructed radiographs (DRRs), we determined how changes in the projection angle influenced the assessment of the subtalar joint.

Materials and methods

Weightbearing computed tomography (CT) scans were acquired in 27 healthy individuals. CT scans were segmented and processed to create DRRs of the hindfoot. DRRs were obtained to represent 25 different perspectives to simulate internal rotation of the ankle with and without caudal angulation of the X-ray beam. Subtalar joint morphology was quantified by determining the joint space curvature, subtalar inclination angle (SIA), calcaneal slope (CS), and projection of the subtalar joint line on three-dimensional (3-D) reconstructions of the calcaneus.

Results

The curvature of the projected joint space was altered substantially over the different DRR projections. Simulated caudal angulation of the X-ray beam with respect to the ankle decreased the SIA and CS significantly. Internal rotation also had a significant impact on the SIA and CS if the X-ray beam was in neutral or in 10° of caudal angulation. An antero-posterior (AP) view of the ankle showed the posterior area of the posterior facet, whereas a more anterior area was visible with internal rotation of the foot and caudal angulation of the X-ray beam.

Conclusion

Internal rotation of the foot of 20° is recommended to assess the posterior aspect of the posterior facet, whereas a combined 20° internal rotation of the foot and 40° caudal angulation of the X-ray beam is best to assess the anterior aspect of the posterior facet of the subtalar joint.

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Acknowledgments

The authors thank Andrew E. Anderson, PhD, research associate professor at the University of Utah, who provided technical and editorial support.

Funding

This work was supported by a grant from the Swiss Society of Orthopaedic Surgery (Swiss Orthopaedics). It was also supported by the LS Peery Foundation (University of Utah) and by the National Institutes of Health (NIH-R21AR063844). Nicola Krähenbühl received a grant from the Swiss National Science Foundation (SNF; grant number P2BSP3_174979).

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Author notes

  1. Amy L. Lenz and Nicola Krähenbühl contributed equally to this work

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84132, USA

    Amy L. Lenz, Nicola Krähenbühl, Kalebb Howell, Rich Lisonbee, Charles L. Saltzman & Alexej Barg

  2. Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland

    Beat Hintermann

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  1. Amy L. Lenz
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  2. Nicola Krähenbühl
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  5. Beat Hintermann
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  6. Charles L. Saltzman
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  7. Alexej Barg
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Correspondence to Alexej Barg.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The investigation was performed at the University of Utah, Salt Lake City, USA

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Lenz, A.L., Krähenbühl, N., Howell, K. et al. Influence of the ankle position and X-ray beam angulation on the projection of the posterior facet of the subtalar joint. Skeletal Radiol 48, 1581–1589 (2019). https://doi.org/10.1007/s00256-019-03220-1

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  • DOI: https://doi.org/10.1007/s00256-019-03220-1

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