A comparison of three methods of measuring tibial torsion in children with myelomeningocele and normally developing children

Borish, Cassie N.; Mueske, Nicole M.; Wren, Tishya A. L.

doi:10.1002/ca.22894

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…Even if calculated on the basis of three-dimensional landmark coordinates, their measurement technique only uses four points to define the torsion of a volumetric body. An interesting approach was proposed by Borish et al where tibial torsion was measured using a capture motion system [ 44 ]. This is valuable with the increasing possibilities for dynamic analyses.…”

Section: Discussionmentioning

confidence: 99%

Tibial torsion analysis in computed tomography: development and validation of a real 3D measurement technique

et al. 2021

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Purpose Pathological tibial torsion is known to negatively influence the functionality of the lower extremity, and therefore, its assessment might play an important role. While 3D imaging is used for many examinations of the musculoskeletal system, for the determination of tibial torsion no 3D measurement technique has been available so far. We developed a 3D measurement method and assess its interobserver reliability as well as its correlation with standard 2D measurement methods. Methods CT scans of 82 tibiae in 79 patients with a mean age of 41 years were included. A novel 3D measurement technique was developed and applied. Measurements were compared with two frequently used 2D measurement methods. ICC (intraclass correlation coefficient) for the new technique was determined and compared to the 2D measurement method. Furthermore, differences between left and right legs as well as between males and females were assessed. Results The ICC for the 2D methods was 0.917 and 0.938, respectively. For the 3D measurements, ICCs were calculated to be 0.954 and 0.950. Agreement between 2 and 3D methods was moderate to good with ICCs between 0.715 and 0.795. Torsion values for left and right legs did not differ significantly in 2D and in 3D (26.2 vs 28.5° and 27.2 vs. 25.9°). The same is true for the differences between male and female in 2D and 3D (26.2 vs. 29.6° and 25.0 vs. 31.2°). Conclusion The newly developed 3D measurement technique shows a high intraclass agreement and offers an applicable opportunity to assess the tibial torsion three-dimensionally.

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Section: Discussionmentioning

confidence: 99%

Tibial torsion analysis in computed tomography: development and validation of a real 3D measurement technique

et al. 2021

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Longo

Nicetto²,

Pozzi

et al. 2020

Veterinary Surgery

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Objective To describe a three‐dimensional (3D) computed tomographic (CT) methodology to measure the tibial torsion angle (TTa) and to evaluate intrarater and interrater agreements and accuracy through comparison with anatomic measurements. Study design Ex vivo cadaveric study. Sample population Thirty‐six tibiae from 18 dogs. Methods Tibial torsion angle of each tibia was measured by using two CT techniques (axial and 3D volume rendering) by three raters who blindly measured TTa in duplicate. A semitransparent bone filter was used to enhance the visibility of the target anatomical landmarks for the 3D volume rendering CT technique. Tibial torsion angle was also quantitated in tibial specimens. Intrarater and interrater agreements were analyzed by using intraclass coefficients (ICC). Accuracy was evaluated by using adjusted R2 coefficients (R2 > 80% was considered acceptable). Results The 3D volume rendering CT technique had excellent intrarater and interrater agreements (ICC > 0.94) and an R2 value of 97%. The axial CT technique had good to excellent intrarater and interrater agreements (0.8 < ICC < 0.95) and an R2 of 86%. No difference was found between axial and 3D CT techniques. A mean internal TT angle of approximately −6° was found with CT and anatomic measurements. Conclusion The 3D volume rendering and axial CT techniques were precise and accurate for measuring TTa in dogs unaffected by patellar luxation. Clinical relevance Combining 3D bone manipulation with application of a semitransparent filter allows simultaneous visualization of anatomic landmarks, which may facilitate the evaluation of complex bone deformations. Internal tibial torsion may be present in nonchondrodystrophic dogs without patella luxation.

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“…Since first described by Le Damany in 1903, 52 tibial torsion has been assessed using a range of methods. Although computed tomography (CT) is the recognized gold standard for measurement, 1 , 16 , 44 concerns regarding exposure to radiation have led to the exploration of less invasive approaches. These include clinical, 29 , 45 motion capture, 1 ultrasound, 3 digital inclinometer, 46 and fluroscopy 4 methods.…”

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confidence: 99%

“…Although computed tomography (CT) is the recognized gold standard for measurement, 1 , 16 , 44 concerns regarding exposure to radiation have led to the exploration of less invasive approaches. These include clinical, 29 , 45 motion capture, 1 ultrasound, 3 digital inclinometer, 46 and fluroscopy 4 methods. However, these methods have significant limitations, and none provides valid and reliable torsion measurement comparable with CT. 1 , 3 , 4 , 24 Magnetic resonance imaging (MRI) offers a nonionizing, radiation-free option from which values equivalent to those derived from CT have been reported for tibial torsion assessment when the same anatomic reference lines are applied.…”

mentioning

confidence: 99%

“…These include clinical, 29 , 45 motion capture, 1 ultrasound, 3 digital inclinometer, 46 and fluroscopy 4 methods. However, these methods have significant limitations, and none provides valid and reliable torsion measurement comparable with CT. 1 , 3 , 4 , 24 Magnetic resonance imaging (MRI) offers a nonionizing, radiation-free option from which values equivalent to those derived from CT have been reported for tibial torsion assessment when the same anatomic reference lines are applied. 30 This offers significant potential because contrasts between bone and soft tissue improve on MRI, giving more certainty to bony contours and landmarks, meaning normative data could be collected from healthy individuals, in particular young patients, without concern for radiation exposure.…”

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confidence: 99%

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A Validated, Automated, 3-Dimensional Method to Reliably Measure Tibial Torsion

et al. 2021

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Background: Tibial torsion is a twist in the tibia measured as an angle between a proximal axis line and a distal axis line. Abnormal torsion has been associated with a variety of painful clinical syndromes of the lower limb. Measurements of normal tibial torsion reported by different authors vary by 100% (ranging from 20° to 42°), making it impossible to determine normal and pathological levels. Purpose: To address the problem of unreliable measurements, this study was conducted to define an automated, validated computer method to calculate tibial torsion. Reliability was compared with current clinical methods. The difference between measurements of torsion generated from computed tomography (CT) and magnetic resonance imaging (MRI) scans of the same bone, and between males and females, was assessed. Study Design: Controlled laboratory study. Methods: Previous methods of analyzing tibial torsion were reviewed, and limitations were identified. An automated measurement method to address these limitations was defined. A total of 56 cadaveric and patient tibiae (mean ± SD age, 37 ± 15 years; range, 17-71 years; 28 female) underwent CT scanning, and 3 blinded assessors made torsion measurements by applying 2 current clinical methods and the automated method defined in the present article. Intraclass correlation coefficient (ICC) values were calculated. Further, 12 cadaveric tibiae were scanned by MRI, stripped of tissue, and measured using a structured light (SL) scanner. Differences between torsion values obtained from CT, SL, and MRI scans, and between males and females, were compared using t tests. SPSS was used for all statistical analysis. Results: When the automated method was used, the tibiae had a mean external torsion of 29°± 11° (range, 9°-65). Automated torsion assessment had excellent reliability (ICC, 1), whereas current methods had good reliability (ICC, 0.78-0.81). No significant difference was found between the torsion values calculated from SL and CT ( P = .802), SL and MRI ( P = .708), or MRI and CT scans ( P = .826). Conclusion: The use of software to automatically perform measurements ensures consistency, time efficiency, validity, and accuracy not possible with manual measurements, which are dependent on assessor experience. Clinical Relevance: We recommend that this method be adopted in clinical practice to establish databases of normal and pathological tibial torsion reference values and ultimately guide management of related conditions.

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A comparison of three methods of measuring tibial torsion in children with myelomeningocele and normally developing children

Cited by 19 publications

References 32 publications

Tibial torsion analysis in computed tomography: development and validation of a real 3D measurement technique

Tibial torsion analysis in computed tomography: development and validation of a real 3D measurement technique

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

A Validated, Automated, 3-Dimensional Method to Reliably Measure Tibial Torsion

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