Drop landing analysis of rotational osteotomies

Abstract

Pathomechanics resulting from rotational deformities of the long bones in an idiopathic population have not been extensively studied, and are chiefly limited to level over ground walking. Thirty-five adolescents with excessive idiopathic outward tibial torsion (TT), femoral rotation, or both (pan genu) were studied both before and after corrective surgery. Data collected included computational motion analysis of a drop jump and patient-reported outcomes consisting of PODCI and Goal Attainment Scores. Results were compared to an age-matched typically developing cohort (n = 25). Subjects with femoral anteversion (FA) exhibited compensatory hip rotations to normalize knee progression angles at landing. Subjects with only TT did not compensate at the hip, landing with typical knee progression but excessive outward foot progression. These strategies resulted in elevated frontal plane knee moments for FA (P = 0.008), and elevated lateral knee forces in all groups compared to typical, with the TT group reaching significance (P < 0.001). Rotational osteotomies successfully restored elevated kinematics and kinetics to within or below typically developing ranges. Patient-reported outcomes generally improved after surgery across all domains studied. Drop jump testing elucidated compensation strategies employed by these cohorts. Compensation did not fully alleviate elevated forces at the knees. Surgical intervention normalized pathokinematics and pathokinetics, reduced pain, and improved patients’ perception of their functional abilities. Greater improvements were found in individuals in the two groups with FA compared to the group with TT only.

Tibial derotational osteotomy for idiopathic tibial torsion: A systematic review of surgical indications based on clinical presentation and measurement technique

“…Anterior knee pain, patellar instability or both symptoms were surgical indicators for treating idiopathic tibial torsion in all included articles of our study [2-4, 7-9, 17, 25, 27-29, 32, 36, 38, 45-47]. Knee pain and instability are common debilitating symptoms encountered by patients with lower extremity rotational deformities [45]. While these symptoms often require prompt management, several causes must be considered in addition to tibial torsion, such as pan genu torsion, knee rotation and increased femoral anteversion [10,13,18,49].…”

“…Anterior knee pain 3 (18%) [3,25,29] Patellar instability 2 (12%) [9,32] Gait dysfunction 1 (6%) [47] Cosmesis 1 (6%) [36] Pain/instability 4 (24%) [4,8,17,45] Pain/gait 2 (12%) [7,28] Pain/cosmesis 1 (6%) [36] Pain/gait/instability 4 (24%) [27,38,46,47] Pain/gait/cosmesis 1 (6%) [2] a…”

“…Computerized tomography (CT) was used in nine articles to confirm physical exam findings preoperatively (Table 7). Of these nine, two did not report their CT results [32,45]. Two other studies utilized CT both pre-and postoperatively [25,38].…”

“…Two other studies utilized CT both pre-and postoperatively [25,38]. With the exception of Dickschas et al and Lisse et al, all studies that reported their method of assessment for tibial torsion on CT utilized TMA with respect to the posterior tibia condylar axis (line tangential to the posterior tibia condyles) or the bicondylar tibia axis (line bisecting the tibia condyles) [2,3,8,17,25,27,29,32,38,45,47]. The mean TMA for ETT on CT was at least 36°prior to surgical correction.…”

“…TDO was located at or proximal to the tibial tuberosity in 10 studies (59%), at the middiaphysis in one (6%) and distally at the supramalleolar region in four (24%). Three studies (18%) performed TDO at more than one level but did not divide the results into different cohorts [3,7,45]. Eight studies reported using various validated functional outcome measures and noted statistically significant improvements after TDO [4,8,9,17,27,29,32,46].…”