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Updated: May 8, 2026

Four-Dimensional CT Analysis Using Sequential 3D-3D Registration
Published on: November 23, 2019
Which radiographic plane should be used to quantify the distal tibia angle on weightbearing CT images?
Jules Rasschaert1, Pedro Drummond2, Cédric Bonte3
1Ghent University Hospital, Faculty of Medicine and Healthcare Sciences, Corneel Heymanslaan 10, Ghent, OVL 9000, Belgium.
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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