X-ray of ankle osteoarthritis

From radlines.org
Jump to navigation Jump to search

Author: Mikael Häggström [notes 1]

X-ray of ankle osteoarthritis.jpg


Weight-bearing radiography.


The Kellgren-Lawrence scale has been recommended,[1] but in practice it is generally acceptable to give the degree as mild/moderate or severe.

Kellgren-Lawrence system
Grade Description
0 No radiographic features of osteoarthritis
1 Osteophyte formation and possible joint space narrowing. The normal distances between the bones in the ankle are as follows:[2]
  • Talus - medial malleolus : 1.70 ± 0.13 mm
  • Talus - tibial plafond: 2.04 ± 0.29 mm
  • Talus - lateral malleolus: 2.13 ± 0.20 mm
2 Definite osteophyte formation with possible joint space narrowing
3 Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity
4 Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity

Evaluate separately for the lateral versus medial side of the joint.

Varus or valgus

X-ray of frontal tibiotalar surface angle (TTS).jpg

Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface.[3] An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus.[4]


  • Severity grading:
  • A subjective grading of osteoarthritis is generally warranted, such as mild, moderate or severe, which may correspond to grades 1/2, 3 and 4, respectively, of the Kellgren-Lawrence scale. In Swedish practice, such subjective grading is regarded as sufficient to report for osteoarthritis, since the management of the disease depends on symptoms[5] and any varus/valgus deformity[6] rather than the exact grading of imaging findings.
  • The most severe feature(s) of the osteoarthritis, such as joint space narrowing.
  • Any varus/valgus deformity, and if such, the degree thereof.


X-ray of ankle osteoarthritis.jpg

Osteoarthritis which is severe medially with marked joint space narrowing. Varus deformity with frontal tibiotalar surface angle of 72°.

See also: General notes on reporting


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. Nicolas Holzer, Davide Salvo, Anne Karien Marijnissen, Aminudin Che Ahmad, Emanuele Sera, Pierre Hoffmeyer, Anne Lübbeke Wolff, Mathieu Assal (2017-09-14). "How to assess ankle osteoarthritis: comparison of the Kellgren and Lawrence scale with functional outcome and digital image analysis ". Orthopaedic Proceedings 94-B. Archived from the original. . 
  2. Imai, Kan; Ikoma, Kazuya; Kido, Masamitsu; Maki, Masahiro; Fujiwara, Hiroyoshi; Arai, Yuji; Oda, Ryo; Tokunaga, Daisaku; et al. (2015). "Joint space width of the tibiotalar joint in the healthy foot ". Journal of Foot and Ankle Research 8 (1). doi:10.1186/s13047-015-0086-5. ISSN 1757-1146. 
  3. Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat (2012). "The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles ". Skeletal Radiology 41 (12): 1567–1573. doi:10.1007/s00256-012-1421-6. ISSN 0364-2348. 
  4. Chapter 5 - Radiological morphology of peritalar instability in varus and valgus tilted ankles, in: T.L. Nosewicz (2018-09-25). Acute and chronic aspects of hindfoot trauma . University of Amsterdam, Faculty of Medicine (AMC-UvA). ISBN 9789463750479. 
  5. . Joint distraction for ankle osteoarthritis, Interventional procedures guidance. National Institute for Health and Care Excellence (NICE) (2015-12-16).
  6. Barg, Alexej; Pagenstert, Geert I.; Hügle, Thomas; Gloyer, Marcel; Wiewiorski, Martin; Henninger, Heath B.; Valderrabano, Victor (2013). "Ankle Osteoarthritis ". Foot and Ankle Clinics 18 (3): 411–426. doi:10.1016/j.fcl.2013.06.001. ISSN 10837515.