The Availability of Radiological Measurement of Tibial Torsion: Three-Dimensional Computed Tomography Reconstruction

Abstract

ObjectiveTo assess the intra-rater and inter-rater reliability for measuring tibial torsion measurements by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT) and to compare the physical measures to those of 3D-CT.MethodThe study included 33 children who presented with intoeing gait. Tibial torsion was measured by 3D-CT. Distal reference point was the bimalleolar axis. Proximal reference points were the transtibial axis and posterior condylar axis. Physical measurements included thigh-foot angle (TFA) and bimalleolar angle (BMA). 3D-CT measurement and physical measurement were performed twice at both lower extremities by each rater. The intra-rater and inter-rater reliability were calculated by intraclass correlation coefficiency (ICC). The relationship between radiological and physical examination was calculated by Spearman correlation coefficient.ResultsThe 3D-CT measures for tibial torsion were reliable within individual raters and between different raters. However, physical measures for tibial torsion were reliable within an individual rater but not reliable between raters. The 3D-CT measures by any proximal reference axis were more reliable within a rater and between raters than physical measurements. There was no significant impact introduced by the selection of the proximal reference axis. The correlation coefficiency between 3D-CT and physical measurement methods was low.ConclusionBecause the 3D-CT measurements for tibial torsion are more reliable than physical measurements, we recommend that accurate diagnosis of internal tibial torsion should be detected by using 3D-CT measurements. Also, considering the disadvantages of radiological measurements, physical measurement may be used for short term follow-up by same raters, as intra-rater reliability is relatively good.

Femoral Version and Tibial Torsion are Not Associated With Hip or Knee Arthritis in a Large Osteological Collection

“…1,2,21 Although there have been attempts to quantify both tibial torsion and femoral anteversion on computed tomography and other advanced imaging, these techniques are not a common part of most practitioner's workup because they offer lower interrelator reliability than physical examination and introduce unnecessary testing. 1,7,8,[11][12][13][14][22][23][24][25][26][27][28][29] Treatment practices vary widely regarding the surgical management of these conditions. At our institution patients may be considered for a derotational osteotomy if they are symptomatic and have notable deformity beyond age 6 years for tibial torsion and 8 years for femoral anteversion.…”

“…This introduces a similar problem found in radiographic studies; however, other authors using similar bony landmarks found excellent correlations with physical examination findings. 8,12,14,24,36 In addition, manipulating the bones in-hand allowed for precise localization and positioning of specimens that was not limited to the orthogonal planes in reformatted computed tomographic scans. The cadaveric skeletons used in this study were devoid of articular cartilage; we were thus unable to assess degenerative joint disease at this location.…”

“…Although numerous bony landmarks have been used to quantify tibial rotation radiographically, the midpoint of the tibial plateau surfaces and the anterior tibial plafond were chosen given their high interrelator reliabilities in previous studies, and ease of use in an osteological setup. [7][8][9][10][11][12][13][14][15] Tibial torsion in the internal direction was defined as increased tibial torsion.…”

Femoral and tibial torsion measurements based on EOS imaging compared to 3D CT reconstruction measurements

“…The reliability and reproducibility of two-dimensional CT scans are limited by anatomical determination, especially along the femoral neck axis (7,8), and by positional variables that influence the accuracy of measurement (9). 3D CT reconstruction enables the precise determination of femoral and tibial torsion without influence from femoral or tibial positioning and the determination of femoral neck axis (10,11).…”

A three‐dimensional computed tomographic volume rendering methodology to measure the tibial torsion angle in dogs

“…In human medicine, different diagnostic approaches such as clinical examination, 16,21 radiography, 13,22 computed tomography (CT), 12,[23][24][25] ultrasound, 26 and fluoroscopy 15,27 have been described for assessing TT. The accuracy of radiography 18 and CT 28 have been investigated in the first reports in veterinary medicine focusing on TT.…”