Measurement of tibial torsion—a new technique applicable to ultrasound and computed tomography

Butler-Manuel, P. A.; Guy, R.; Heatley, F.W.

doi:10.1259/0007-1285-65-770-119

Cited by 50 publications

(40 citation statements)

References 17 publications

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“…The validity of CT measurements of tibial torsion was determined in cadaveric studies [3,11]. Its use has been advocated in numerous studies [2,3,7,11,12,25]. Other methods such as MRI [17,18,24] and ultrasound [2,10] also are valid tools for measuring the level of tibial torsion and can be used as reference standards.…”

Section: Discussionmentioning

confidence: 99%

“…Its use has been advocated in numerous studies [2,3,7,11,12,25]. Other methods such as MRI [17,18,24] and ultrasound [2,10] also are valid tools for measuring the level of tibial torsion and can be used as reference standards. However, because CT was invented earlier, studies on the validity of MRI and ultrasound have used CT as the reference standard [2,18].…”

Section: Discussionmentioning

confidence: 99%

“…Other methods such as MRI [17,18,24] and ultrasound [2,10] also are valid tools for measuring the level of tibial torsion and can be used as reference standards. However, because CT was invented earlier, studies on the validity of MRI and ultrasound have used CT as the reference standard [2,18]. The reference lines for CT in this study are the bimalleolar and posterior condylar axes (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…For the distal reference line, some studies advocated the bimalleolar axis [7,11] as the reference line. Some advocated other axes such as the center of the tibia [12] or dorsal border of the tibia [2]. For the proximal reference line, the transtibial [11] and posterior condylar axes [2,7,12] are widely used.…”

Section: Discussionmentioning

confidence: 99%

“…Some advocated other axes such as the center of the tibia [12] or dorsal border of the tibia [2]. For the proximal reference line, the transtibial [11] and posterior condylar axes [2,7,12] are widely used. However, these two reference lines are similar in the juxtaarticular area [7].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee¹,

Chung²,

Park

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Physical examinations of tibial torsion are used for preoperative planning and to assess outcomes of tibial osteomy in patients with cerebral palsy (CP). The thigh-foot angle (TFA) and transmalleolar axis (TMA) are commonly used, and the second toe test recently was introduced. However, the validity and reliability of the three methods have not been clarified. This study was performed to evaluate the validity and reliability of these physical measures. We recruited 18 patients (36 limbs) with CP. During reliability sessions, three raters with various levels of orthopaedic experience independently measured tibial torsion using the three different methods during one day before surgery. Validity was assessed by performing a correlation study between physical examination and two-dimensional computed tomographic (CT) findings. Interobserver reliability was greatest for the TMA followed by TFA and then by the second toe test with intraclass correlation coefficients of 0.92, 0.74, and 0.57, respectively. In terms of the concurrent validity, the correlation coefficients (r) for the CT measurements were 0.62, 0.52, and 0.55. When depicting tibial torsion by physical examination, all three methods had substantial validity, but test reliability and validity were highest for TMA measurements.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee¹,

Chung²,

Park

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Validity and reliability of existing and modified clinical methods of measuring femoral and tibiofibular torsion in healthy subjects: Use of different reference axes may improve reliability

et al. 2004

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Previous studies have evaluated reliability and validity of clinical measurements of femoral and tibiofibular torsion, however, the results are conflicting, warranting an alternative method. The authors developed modified methods of measuring femoral and tibiofibular torsion using different reference axes, and validity and reliability of the modified and existing methods were examined in healthy subjects. Reference values were established using magnetic resonance imaging (MRI) for the validity study. There were significant differences between all clinical methods and corresponding MRI outcomes (P <0.05), whereas Pearson's correlation coefficients between the clinical methods and MRI ranged from 0.67-0.92. For modified methods, intraclass correlation coefficients were 0.89-0.97, whereas those of existing methods were 0.75-0.81. Modified methods were more precise, with standard error of measurements (SEM) of 1.5-2.9 degrees , compared to existing methods (SEM=4.0-5.1 degrees). These results indicate that clinical methods available currently do not accurately measure true torsion of the femur and tibia. Nevertheless, the clinical methods may be useful for screening and descriptive purposes as indices of true torsion, and use of different reference axes could improve their reliability.

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

2017

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INTRODUCTION Abnormal tibial torsion is a common pediatric problem, and there are many existing measurement methods. The purpose of this study was to compare three methods of measuring tibial torsion for its evaluation: computed tomography, physical examination, and motion capture. MATERIALS AND METHODS Twenty healthy children and 20 children with myelomeningocele underwent measures of tibial torsion bilaterally. Measurements were compared using correlation and Bland-Altman plots of the difference between measurements. RESULTS All three measurements were moderately correlated in controls (r≥0.49, p≤0.002) and in patients (r≥0.51, p≤0.001). In controls, the motion capture measurements were on average 2° more lateral than the clinical measurements whereas motion capture and clinical measurements were 13° and 15° more medial than CT measurements, respectively. Similarly for patients, motion capture measurements were on average 5° more medial than clinical measurements, and motion capture and clinical measurements were 26° and 22° more medial than CT measurements. CONCLUSIONS The approximate 20° difference between the clinical or motion capture measures and the CT measure suggests that clinical evaluation identifies different axes than those defined based on skeletal anatomy. Clinical or motion capture methods may be used in lieu of imaging methods for measuring tibial torsion with the knowledge that these methods provide less lateral measurements than measurements obtained using CT.

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Measurement of tibial torsion—a new technique applicable to ultrasound and computed tomography

Cited by 50 publications

References 17 publications

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Validity and reliability of existing and modified clinical methods of measuring femoral and tibiofibular torsion in healthy subjects: Use of different reference axes may improve reliability

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

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