Rotational Deformity—When and How to Address Femoral Anteversion and Tibial Torsion

2022 ◽  
Vol 41 (1) ◽  
pp. 27-46
Author(s):  
Benjamin Noonan ◽  
Trenton Cooper ◽  
Michael Chau ◽  
Melissa Albersheim ◽  
Elizabeth A. Arendt ◽  
...  
Keyword(s):  
Femoral Anteversion ◽  
Tibial Torsion ◽  
Rotational Deformity

Assessment of Tibial Torsion Employing Fluoroscopy, Computed Tomography and the Cryosectioning Technique

1989 ◽  
Vol 30 (1) ◽  
pp. 75-80 ◽  
Author(s):  
B.-G. Clementz ◽  
A. Magnusson
Keyword(s):  
Computed Tomography ◽  
Tibial Fracture ◽  
Medial Malleolus ◽  
Maximum Difference ◽  
Tibial Torsion ◽  
Rotational Deformity ◽  
Anatomic Landmarks ◽  
Single Determination ◽  
Femoral Condyles

Accurate assessment of tibial torsion, particularly the rotational deformity of a stabilized tibial fracture, demands precise anatomic landmarks at the proximal and distal measuring sites of the tibia. A fluoroscopic method has been proposed, utilizing the orientation of the femoral condyles and the medial malleolus to constitute two lines of reference. The relevance of using these structures for the assessment was studied while employing fluoroscopy, computed tomography, and the cryosectioning technique in 10 necropsy specimens of the human tibia. In all specimens the lines of reference were determined by each method and the tibial torsion was measured as the angle between the lines. The medial malleolus and the femoral condyles were found to present reliable anatomic landmarks for determination of the lines of reference in all employed techniques. The maximum difference between results obtained with different methods in a given specimen was 5.4°. The average difference between results with two techniques and two observers varied from 1.0 to 1.5°. The reproducibility of the fluoroscopic method, described by the estimated standard error of a single determination, was 1.3°.

Relationship between femoral anteversion and tibial torsion: CT evaluation of 38 unilateral developmental dysplasia of the hip patients

2018 ◽  
Vol 28 (5) ◽  
pp. 548-553
Author(s):  
Kyu-Jin Cho ◽  
Kyung-Soon Park ◽  
Young-Rok Shin ◽  
Hong-Yeol Yang ◽  
Taek-Rim Yoon
Keyword(s):  
Wide Spectrum ◽  
Group Analysis ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Tibial Torsion ◽  
Individual Comparison ◽  
Significant Difference ◽  
Ct Evaluation ◽  
Group B ◽  
Dysplasia Of The Hip

Introduction: Patients with developmental dysplasia of the hip (DDH) present with a wide spectrum of deformities. Few studies have assessed the relationship between femoral anteversion (FA) and rotational profile. The aim of this study is to evaluate the influence of FA on the lower extremity rotational profile by comparing tibial torsion (TT) between the extremities on both sides in patients with unilateral DDH, using computed tomography (CT). Patients and methods: Thirty eight patients with unilateral developmental dysplasia of the hip, who underwent a preoperative rotational profile CT scan at our institution, were evaluated. 3D rotational profile CT was performed, and FA and TT of the extremities on both sides were measured. Results: On individual comparison of the rotational profile, mean FA of the affected extremity showed a significantly higher value ( p = 0.006). But, there was no significant difference in mean TT between the 2 extremities. On group analysis, the excessive FA group (group B) showed significantly higher values of tibial torsion and tibial torsion side-to-side difference compared to the normal FA group (group A) ( p = 0.000, p = 0.011, respectively). Conclusions: Our study suggests that patients with DDH can present with excessive FA. Therefore, while treating patients who show excessive FA, surgeons must consider the possibility of a higher rotational profile of the affected extremity, before performing surgical treatments for DDH.

scholarly journals Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

2021 ◽  
Vol 10 (14) ◽  
pp. 3035
Author(s):  
Robert C. Palmer ◽  
David A. Podeszwa ◽  
Philip L. Wilson ◽  
Henry B. Ellis
Keyword(s):  
Patellar Dislocation ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Lateral Displacement ◽  
Patellofemoral Instability ◽  
Femoral Anteversion ◽  
Transverse Plane ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Tibial Torsion

Patellofemoral instability (PFI) encompasses symptomatic patellar instability, patella subluxations, and frank dislocations. Previous studies have estimated the incidence of acute patellar dislocation at 43 per 100,000 children younger than age 16 years. The medial patellofemoral ligament (MPFL) complex is a static soft tissue constraint that stabilizes the patellofemoral joint serving as a checkrein to prevent lateral displacement. The causes of PFI are multifactorial and not attributed solely to anatomic features within the knee joint proper. Specific anatomic features to consider include patella alta, increased tibial tubercle–trochlear groove distance, genu valgum, external tibial torsion, femoral anteversion, and ligamentous laxity. The purpose of this paper is to provide a review of the evaluation of PFI in the pediatric and adolescent patient with a specific focus on the contributions of coronal and transverse plane deformities. Moreover, a framework will be provided for the incorporation of bony procedures to address these issues.

scholarly journals Identifying Relationships Among Lower Extremity Alignment Characteristics

2009 ◽  
Vol 44 (5) ◽  
pp. 511-518 ◽  
Author(s):  
Anh-Dung Nguyen ◽  
Sandra J. Shultz
Keyword(s):  
Lower Extremity ◽  
Injury Risk ◽  
Femoral Anteversion ◽  
Tibial Torsion ◽  
Tibiofemoral Angle ◽  
Navicular Drop ◽  
Lower Extremity Alignment ◽  
Select Group ◽  
Genu Recurvatum ◽  
The Relationship

Abstract Context: The relationship between lower extremity alignment and lower extremity injury risk remains poorly understood, perhaps because most authors have examined only individual or a select group of alignment variables. Examining the relationships among alignment variables may allow us to more accurately describe lower extremity posture and clarify the relationship between lower extremity alignment and injury risk in future studies. Objective: To measure lower extremity alignment variables and examine whether relationships could be identified among these variables. Design: Observational study. Setting: Laboratory. Patients or Other Participants: Two hundred eighteen (102 males: age  =  23.1 ± 3.2 years, height  =  177.3 ± 8.4 cm, mass  =  80.8 ± 13.0 kg; 116 females: age  =  21.8 ± 2.7 years, height  =  163.5 ± 7.4 cm, mass  =  63.4 ± 12.4 kg) healthy, college-aged participants. Main Outcome Measure(s): We measured pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, and tibial torsion to the nearest degree and navicular drop to the nearest millimeter on the right and left lower extremities. Separate principal components factor analyses were performed for each sex and side (left, right). Results: A distinct lower extremity factor was identified, with relationships observed among increased pelvic angle, increased quadriceps angle, and increased tibiofemoral angle. A second distinct lower extremity factor was identified, with relationships observed among increased supine genu recurvatum, decreased tibial torsion, and increased navicular drop. Femoral anteversion loaded as an independent third factor. These distinct lower extremity alignment factors were consistent across side and sex. Conclusions: Factor analysis identified 3 distinct lower extremity alignment factors that describe the potential interactions among lower extremity alignment variables. Future authors should examine how these collective alignment variables, both independently and in combination, influence dynamic knee function and risk for lower extremity injuries.

scholarly journals A New Factor Predicting Excessive Femoral Anteversion in Patients with Recurrent Patellar Dislocation

2021 ◽  
Author(s):  
Conglei Dong ◽  
Kuo Hao ◽  
Chao Zhao ◽  
Fei Wang
Keyword(s):  
Lower Limb ◽  
Patellar Dislocation ◽  
Pearson Correlation ◽  
Ct Scanning ◽  
Femoral Anteversion ◽  
Control Group ◽  
Imaging Method ◽  
Tibial Torsion ◽  
Rotation Parameters ◽  
And Control

Abstract Purpose Determining a new imaging method on full-leg standing lower limb radiographs to predict excessive femoral anteversion in patients with patellar dislocation.Methods This study included 119 patients with patellar dislocation from January 2014 to January 2021. The femoral anteversion and tibial torsion were measured by CT scanning. The medial condylar angle was measured by the full-leg standing lower limb radiographs. Pearson correlation coefficient was used to evaluate the correlation between rotation parameters and medial condylar angle.Results Included patients were divided into DFO group and control group according to whether they received derotational femoral osteotomy (DFO) operation or not. There were significant statistical differences in femoral anteversion, tibial torsion and medial condylar angle between DFO group and control group (P < 0.05). This showed that there was a smaller medial condylar angle in patients undergoing DFO operation. Correlation analysis showed that the values of femoral anteversion were significantly correlated with medial condylar angle (r= -0.719, P < 0.001). Conclusion This study showed that medial condylar angle had a negative correlation with excessive femoral anteversion on the full-leg standing lower limb radiographs. The medial condylar angle can be a good predictor of femoral anteversion and can be used to guide the performance of DFO to treat patellar dislocation in clinical practice.

scholarly journals Evaluation of factors affecting external tibial torsion in patients with cerebral palsy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jae Jung Min ◽  
Soon-Sun Kwon ◽  
Kyu Tae Kim ◽  
Young Choi ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Imaging Study ◽  
Femoral Anteversion ◽  
Affecting Factors ◽  
Tibial Torsion ◽  
Factors Affecting ◽  
3 Dimensional ◽  
Gmfcs Level

Abstract Background Gait deviation and associated torsional problems are common in patients with cerebral palsy (CP). Although femoral anteversion in CP has been extensively reviewed in previous studies, only a few studies have focused on tibial torsion. Therefore, this study aimed to evaluate tibial torsion in patients with CP and investigate the affecting factors. Methods Consecutive patients with cerebral palsy who underwent 3-dimensional computed tomography for the assessment of rotational profiles were reviewed. Femoral anteversion and tibial torsion were measured, and the demographic characteristics of the patients were recorded. A linear mixed model was implemented to overcome the retrospective nature of the study. Results After the implementation of inclusion and exclusion criteria, 472 patients were enrolled for this study. With age, external tibial torsion increased, while femoral anteversion decreased. The factors affecting external tibial torsion were increased femoral anteversion (p = 0.0057), increased age (p < 0.0001), higher Gross Motor Function Classification System (GMFCS) level (p < 0.0001), and involved/uninvolved limbs of hemiplegia (p = 0.0471/p = 0.0047). Conclusions Older age, GMFCS level IV/V, hemiplegia, and increased femoral anteversion were the independent risk factors of increased external tibial torsion; therefore, performing an imaging study is recommended for assessing the extent of tibial torsion in patients with such characteristics.

Femoral anteversion measured by ultrasonography and radiography

1988 ◽  
Vol 29 (6) ◽  
pp. 695-699 ◽  
Author(s):  
S. Anda ◽  
T. Terjesen ◽  
S. Sundalsfoll ◽  
Å. Tangerud
Keyword(s):  
Femoral Anteversion
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