An improved understanding of the ankle joint morphometrics is crucial for continued development of surgical treatment strategies. Furthermore, joint space analysis was not paired with evaluation of bone morphology variation, articular coverage within the joint, or the congruency of mated articular surfaces. Early studies using WBCT established joint space distance relationships of the ankle joint, but analyses were primarily focused on the tibiotalar articular regions 12, 13. Weightbearing cone-beam computed tomography (WBCT) is an emerging volumetric imaging technology that provides an added benefit to assess pathology, joint space narrowing, and loss of joint congruency that may be overlooked in the absence of load 10, 11. Volumetric imaging, such as computed tomography (CT), has made it possible to generate 3D reconstructions of the talocrural joint 8, 9. However, these complex three-dimensional (3D) morphologies are not adequately represented in single 2D measurements that are most often isolated to a single imaging plane 7. Numerous 2D measurements have been developed in attempt to quantify normal and pathological anatomy within the ankle joint, distal syndesmosis and medial/lateral gutter 4– 6. Morphometric understanding of the ankle joint complex has been derived primarily from two-dimensional (2D) measurements of conventional radiographs, with little focus given to the fibula and the complete talocrural joint 2– 5. The talocrural joint is comprised of the articular relationships between the tibia, fibula and talus, including three main articular regions (tibiotalar, tibiofibular and talofibular) 1. These data are helpful to improve understanding of ankle joint pathologies and to guide refinement of operative treatments. The shape analysis also revealed a highly congruent talocrural joint with minimal inter-individual morphometric differences at the articular regions. Key anatomical variation across subjects included the fibular notch on the tibia, talar trochlea sagittal plane rate of curvature, tibial plafond curvature with medial malleolus prominence, and changes in the fibular shaft diameter. Shape models were developed from segmented WBCT images and included the distal tibia, distal fibula, and full talus. In this study we applied statistical shape modeling, a computational morphometrics technique, to objectively quantify anatomical variation, joint level coverage, joint space distance, and congruency at the talocrural joint. Weightbearing cone-beam CT (WBCT) technology provides additional benefit to assess 3D spatial relationships and joint congruency while the patient is load bearing. More recently, high-resolution volumetric imaging, including computed tomography (CT), has enabled the generation of three-dimensional (3D) reconstructions of the talocrural joint. Historically, conventional radiographs have been the primary tool to morphometrically evaluate the talocrural joint, which is comprised of the distal tibia, distal fibula, and proximal talus.
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