The weight-bearing anteroposterior ankle, knee radiographs, and full-length anteroposterior radiographs were taken in all patients at preoperative and final follow-up period of at least 1 year after the surgery. In an effort to detect detailed changes in the radiographic parameters, measurements were performed on the tenfold magnified radiographs. Changes in the ankle joint were assessed with the use of the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA) (Figure 2(a)) [8, 12]. Measurement was performed on weight-bearing anterior-posterior ankle radiograph taken with the patient standing, feet shoulder width apart, and second toes parallel to the coronal plane. The talar tilt angle was defined by the tibial and talar articular surfaces in the ankle joint. The tibiotalar angle was defined as the angle between the anatomical axis of the tibia and the line drawn parallel to the talar dome. The LDTA was defined as the angle between the tibial anatomical axis and the distal tibial articular surface on the standing ankle anteroposterior radiographs.

(a) Weight-bearing ankle anteroposterior view showing measurement of the lateral distal tibial angle (LDTA), tibiotalar angle (TTA), and talar tilt angle. The tibial axis was drawn by bisecting two pairs of points along the tibial shaft cortex, drawn 100 and 150 mm proximal to the tibial plafond. (b) Weight-bearing knee anteroposterior view showing measurement of the medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and medial and lateral joint space widths. The tibial axis was drawn by bisecting two pairs of points along the tibial shaft cortex, drawn 100 and 150 mm distal to the tibial plateau. (c) Full-length anteroposterior radiograph of the lower extremity showing measurement of the mechanical axis deviation angle (MADA) and hip-knee-ankle (HKA) angle. (d) Weight-bearing knee anteroposterior view showing correction angle after SMO.

In addition, changes in the knee joint were assessed with medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively) [13], and medial and lateral joint line convergence angles (JLCA) [14]. Measurement was performed on weight-bearing anteroposterior knee radiographs taken with the patient standing, feet shoulder width apart, and both patella heading forward (Figure 2(b)). MPTA was defined by the angle between the tibial mechanical axis and the articular surface line of the proximal tibia. mJSW and lJSW were measured as the shortest distance between the distal femur and the proximal tibia for the medial and lateral joint spaces of each knee. JLCA was measured as the angle formed between a line tangential to the distal femoral condyle and the tibial plateau.

Moreover, changes in lower limb alignment were assessed with mechanical axis deviation angle (MADA) [12] and hip-knee-ankle (HKA) angle [8] measured on full-length anteroposterior radiograph of the lower extremity. MADA was defined as the angle formed by the line connecting the hip centre to the ankle centre and the tibial mechanical axis, while the HKA angle was the angle between the mechanical axes of the femur and the tibia (Figure 2(c)).

Lastly, the correction angle of SMO was measured as the angle between the proximal and distal osteotomized ends (Figure 2(d)).

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