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Distal Tibial Rotation Osteotomies Normalize Frontal Plane Knee Moments
Bruce A. MacWilliams, PhD1; Mark L. McMulkin, PhD2; Glen O. Baird, MD2; Peter M. Stevens, MD3
1 Motion Analysis Laboratory, Shriners Hospitals for Children-Salt Lake City, Fairfax Road at Virginia Street, Salt Lake City, UT 84103. E-mail address: bmacwilliams@shrinenet.org
2 Motion Analysis Laboratory, Shriners Hospitals for Children-Spokane, 911 West 5th Avenue, Spokane, WA 99204. E-mail address for M.L. McMulkin: mmcmulkin@shrinenet.org. E-mail address for G.O. Baird: gbaird@shrinenet.org
3 Primary Children's Medical Center, 100 North Medical Drive, Suite 450, Salt Lake City, UT 84113. E-mail address: peter.stevens@hsc.utah.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Orthofix).

Investigation performed at Shriners Hospitals for Children, Salt Lake City, Utah, and Spokane, Washington

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 01;92(17):2835-2842. doi: 10.2106/JBJS.J.00147
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Torsional deformities of the lower extremity are common in children and are often corrected with rotational osteotomy. The effects of torsional abnormalities, and the effects of corrective osteotomy, are not well understood. A study of children with isolated idiopathic tibial torsional pathology undergoing a single corrective procedure may assist in understanding the biomechanics of torsional deformities and the effect of surgical correction.


Preoperative and postoperative gait analyses were performed for eight subjects (eleven sides) with idiopathic excessive inward tibial torsion and ten subjects (fourteen sides) with excessive outward tibial torsion. Sagittal ankle and frontal knee moments were assessed and compared with those for age-matched controls.


Preoperatively, subjects exhibited abnormal frontal knee moments at push-off. Subjects with inward tibial torsion demonstrated excessive internal valgus moments, and subjects with outward tibial torsion demonstrated reduced internal valgus or relative internal varus moments compared with the control subjects. Ankle power was significantly reduced in the inward torsion group but not in the outward torsion group. Surgical correction of the torsional deformities normalized frontal plane knee moments in both inward and outward torsion groups and restored ankle power in the inward torsion group.


In the present study, excessive tibial torsion adversely affected frontal knee moments and was associated with other kinematic and kinetic abnormalities. Corrective osteotomies improved all variables studied here and restored many to the values found in the control group.

Level of Evidence: 

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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