Document Detail

Coronal plane knee moments improve after correcting external tibial torsion in patients with cerebral palsy.
MedLine Citation:
PMID:  22183475     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: External tibial torsion causes an abnormal axis of joint motion relative to the line of progression with resultant abnormal coronal plane knee moments and affects lever arm function of the foot in power generation at the ankle. However, it is unclear whether surgical correction of the tibial torsion corrects the moments and power.
QUESTIONS/PURPOSES: We evaluated whether surgical correction of external tibial torsion in patients with cerebral palsy would correct the abnormal coronal plane knee moments and improve ankle power generation.
METHODS: We studied 22 patients (26 limbs) with cerebral palsy (Gross Motor Function Classification System Level I or II) who underwent distal internal rotation osteotomies for correction of external tibial torsion as part of a multilevel surgical intervention. There were 10 males and 12 females with a mean age at surgery of 14 years (range, 6.8-20.9 years). All patients had pre- and postoperative standardized clinical evaluation and computerized three-dimensional gait analysis. Minimum followup was 9 months (average, 13 months; range, 9-19 months).
RESULTS: On physical examination, the mean (± SD) transmalleolar axis improved from 43° ± 10° preoperatively to 20° ± 7° postoperatively. Mean knee rotation improved kinematically from 40° ± 9° preoperatively to 21° ± 9° postoperatively. Twenty-two of 26 limbs (88%) improved in one or both peaks of the abnormal coronal plane knee moments. Ankle power generation did not change from preoperative (1.6 ± 0.7 W/kg) to postoperative (1.6 W/kg).
CONCLUSIONS: Correction of external tibial torsion in ambulatory patients with cerebral palsy improves the kinematic and kinetic deviations identified by gait analysis.
LEVELS OF EVIDENCE: Level IV, therapeutic series. See Guidelines for Authors for a complete description of levels of evidence.
Michael Aiona; Kosta Calligeros; Rosemary Pierce
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-03-29     Completed Date:  2012-05-15     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1327-33     Citation Subset:  AIM; IM    
Medical Staff Department, Shriners Hospitals for Children, Portland, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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MeSH Terms
Ankle Joint / physiopathology
Bone Malalignment / physiopathology,  surgery
Cerebral Palsy / diagnosis,  physiopathology,  surgery*
Knee Joint / physiopathology,  surgery*
Osteotomy / methods*
Range of Motion, Articular
Tibia / physiopathology,  surgery*
Torsion Abnormality / physiopathology,  surgery*
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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