Clinical Orthopaedics and Related Research®

, Volume 470, Issue 5, pp 1327–1333

Coronal Plane Knee Moments Improve After Correcting External Tibial Torsion in Patients With Cerebral Palsy

Symposium: Current Approaches in Cerebral Palsy, A Focus on Gait Problems

DOI: 10.1007/s11999-011-2219-x

Cite this article as:
Aiona, M., Calligeros, K. & Pierce, R. Clin Orthop Relat Res (2012) 470: 1327. doi:10.1007/s11999-011-2219-x



External tibial torsion causes an abnormal axis of joint motion relative to the line of progression with resultant abnormal coronal plane knee moments and affects lever arm function of the foot in power generation at the ankle. However, it is unclear whether surgical correction of the tibial torsion corrects the moments and power.


We evaluated whether surgical correction of external tibial torsion in patients with cerebral palsy would correct the abnormal coronal plane knee moments and improve ankle power generation.


We studied 22 patients (26 limbs) with cerebral palsy (Gross Motor Function Classification System Level I or II) who underwent distal internal rotation osteotomies for correction of external tibial torsion as part of a multilevel surgical intervention. There were 10 males and 12 females with a mean age at surgery of 14 years (range, 6.8–20.9 years). All patients had pre- and postoperative standardized clinical evaluation and computerized three-dimensional gait analysis. Minimum followup was 9 months (average, 13 months; range, 9–19 months).


On physical examination, the mean (± SD) transmalleolar axis improved from 43° ± 10° preoperatively to 20° ± 7° postoperatively. Mean knee rotation improved kinematically from 40° ± 9° preoperatively to 21° ± 9° postoperatively. Twenty-two of 26 limbs (88%) improved in one or both peaks of the abnormal coronal plane knee moments. Ankle power generation did not change from preoperative (1.6 ± 0.7 W/kg) to postoperative (1.6 W/kg).


Correction of external tibial torsion in ambulatory patients with cerebral palsy improves the kinematic and kinetic deviations identified by gait analysis.

Levels of Evidence

Level IV, therapeutic series. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Michael Aiona
    • 1
  • Kosta Calligeros
    • 1
  • Rosemary Pierce
    • 1
  1. 1.Medical Staff DepartmentShriners Hospitals for Children, PortlandPortlandUSA