Rotational Malalignment and Femoral Torsion in Osteoarthritic Knees With Patellofemoral Joint Involvement

Bone mineral density of the proximal tibia relates to axial torsion in the lower limb

“…When direct entry multiple linear regression was used, the three variables were able to produce an improved predictive equation of the BMD ratio (r = 0.80, p < 0.001). These results are consistent with previous investigations that found a relationship between knee OA severity and internal tibial torsion, and provide evidence that suggests tibial torsion may be a pathogenic factor [13,14].…”

“…Varus/valgus knee angle and the frontal plane moments that result during gait have been related to bone mineral distribution in the proximal tibia in healthy and diseased knees, implicating them in the pathogenesis of OA [5][6][7]9]. Internal tibial torsion (tibias with lower than normal external torsion angles) and low femoral antetorsion angles have been linked with the incidence and severity of knee OA [10][11][12][13][14]. Studies of non-arthritic knees are needed to determine if the distribution pattern of bone density between the medial and lateral compartments of the proximal tibia is related to lower limb torsion.…”

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.…”

The Influence of Tibial and Femoral Rotation on Patellofemoral Contact Area and Pressure

“…39 The pathophysiology of patellofemoral pain is not well understood. 7,40 While some have attributed patellofemoral pain to excessive stresses associated with abnormal patellofemoral joint mechanics, 27,36 others have concluded that chronic overloading of the patellofemoral joint, rather than malalignment, is a common characteristic in patients with patellofemoral pain. 20,49 Many causes of patellofemoral joint dysfunction have been proposed, including vastus medialis weakness, increased quadriceps angle, genu valgum, femoral anteversion, external tibial torsion, tight lateral retinaculum, abnormalities of the shape of the patella, trochlear groove abnormalities, and foot pronation.…”