Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee, Sang Hyeong; Chung, Chin Youb; Park, Moon Seok; Choi, In Ho; Cho, Tae Joon

doi:10.1007/s11999-009-0705-1

Cited by 57 publications

(39 citation statements)

References 25 publications

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“…Range of motion of the joints, Thomas test [11], Ely test, trochanteric prominence angle test (TPAT) [12], popliteal angle, and thigh-foot angle [13] were included in the physical examination. Range of motion of the joints, Thomas test [11], Ely test, trochanteric prominence angle test (TPAT) [12], popliteal angle, and thigh-foot angle [13] were included in the physical examination.…”

Section: Methodsmentioning

confidence: 99%

Short-term effects of proximal femoral derotation osteotomy on kinematics in ambulatory patients with spastic diplegia

Kwon

Lee

Kim

et al. 2013

Journal of Pediatric Orthopaedics B

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The aim of this retrospective study was to determine the short-term effects of proximal femoral derotation osteotomy (FDO) on gait in 53 ambulatory patients with spastic diplegia controlling all confounding procedures. All patients showed a jump gait pattern and had undergone bilateral rectus femoris transfer, distal hamstring lengthening, and tendo-Achilles lengthening as a single-event multilevel surgery. Of these, additional bilateral proximal FDOs were included in 25 patients, defined as the FDO group; the other 28 patients were defined as the no-FDO group. Kinematic variables, such as pelvic tilt, minimal hip flexion in stance, hip rotation, and foot progression angle, were compared between the two groups at postoperative 1 year. Hip extension, hip rotation, and hip adduction improved significantly after surgery in the FDO group (P<0.001, P=0.004, P=0.028), but not in the no-FDO group. Foot progression angle improved in both groups, but the degree of improvement was significantly greater in the FDO group (P=0.004). In conclusion, FDO improved hip rotation, hip adduction, and hip extension as well as foot progression angle in the ambulatory patients with spastic diplegia showing a jump gait.

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Section: Methodsmentioning

confidence: 99%

Short-term effects of proximal femoral derotation osteotomy on kinematics in ambulatory patients with spastic diplegia

Kwon

Lee

Kim

et al. 2013

Journal of Pediatric Orthopaedics B

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“…On the contrary, the accuracy of CT was verified through a cadaver study,8 and thus most of the studies conducted until now have been to investigate the correlation between physical examination and CT. However, the two measurement methods showed a low correlation and the reliability and reproducibility of CT were superior,5,8 which was also verified in domestic studies 4,9. Other radiological methods including nuclear magnetic resonance and unltrasonography were suggested but these are also limited because the validity was acquired on the basis of the correlation with CT. Additionally, the recent development of medical imaging allows three dimensional computed tomography reconstruction (3D-CT).…”

Section: Introductionmentioning

confidence: 81%

“…Thus, treatment of tibial torsion, the most common cause of intoeing gait, is very important and should be based on accurate diagnosis. Various methods of physical examination and radiologic measurement have been applied to measure the tibial torsion angle 4-6,8,9,11-13…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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“…Among the possible factors contributing to variable reliability; we controlled for body mass index and difficulty in palpating the greater trochanter by excluding subjects who were overweight or obese. The medial collateral ligament laxity and tibial torsion was controlled by the valgus test and the tibial torsion test (Lee et al, 2009) in this study precluding the subjects with lax ligaments and excessive tibial torsion. Thus, the findings of this study suggest that the precise definition, palpation, and placement of the inclinometer in the proximal, proximal third, and proximal half of the tibial crest are necessary to elicit high reliability by producing a consistent femoral anteversion angle.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Femoral Anteversion Angle and Determination of Reliability Measured at Three Different Anatomical References of the Tibial Crest During the Trochanteric Prominence Angle Test

Lee

Yoon²,

Choi³

et al. 2012

Physical Therapy Korea

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1)The trochanteric prominence angle test (TPAT) has been used to measure the femoral anteversion angle between the tibial crest and the vertical line. However, the exact anatomical reference of the tibial crest has not yet been identified in the literature. Thus, the purposes of this research were twofold: first, to compare the femoral anteversion angle measured at three different anatomical references of the tibial crest (the proximal tibial crest, the proximal third of tibial crest, and the proximal half of tibial crest) and, second, to determine inter-and intra-rater reliabilities of the femoral anteversion angle measured at these three different anatomical references of the tibial crest during the TPAT. We recruited 14 healthy subjects, and a total of 28 legs were examined. The TPAT was measured using a digital inclinometer. A 1-way repeated-measure analysis of variance was used to compare the femoral anteversion angle measured at three different anatomical references of the tibial crest, and intraclass correlation coefficients (ICCs) were calculated to determine reliability. The femoral anteversion angle measured at the proximal tibial crest was significantly higher than that at the proximal third of the tibial crest and the proximal half of the tibial crest. The inter-and intra-rater reliabilities of femoral anteversion angle were measured at three anatomic references of the tibial crest were all found to be high during the TPAT (ICC=.9 0～.98). In conclusion, clinicians should recognize that the different degrees of the femoral anteversion angle could be measured when different anatomical references of the tibial crest were used, and that reliabilities were high when an exact anatomical reference of the tibial crest was used during the TPAT.[Ji-hyun Lee, Tae-lim Yoon, Sil-ah Choi, Heon-seock Cynn.

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Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Cited by 57 publications

References 25 publications

Short-term effects of proximal femoral derotation osteotomy on kinematics in ambulatory patients with spastic diplegia

Short-term effects of proximal femoral derotation osteotomy on kinematics in ambulatory patients with spastic diplegia

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

Comparison of Femoral Anteversion Angle and Determination of Reliability Measured at Three Different Anatomical References of the Tibial Crest During the Trochanteric Prominence Angle Test

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