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Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

  • Original Article
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Clinical Orthopaedics and Related Research®

Abstract

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.

Level of Evidence: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank SungJu Kim for statistical advice and Mi Seon Ryu for assistance in data collection.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki, 463-707, Korea

    Sang Hyeong Lee MD, Chin Youb Chung MD & Moon Seok Park MD

  2. Department of Orthopedic Surgery, Seoul National University Children’s Hospital, Seoul, Korea

    In Ho Choi MD & Tae-Joon Cho MD

Authors
  1. Sang Hyeong Lee MD
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  2. Chin Youb Chung MD
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  3. Moon Seok Park MD
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  4. In Ho Choi MD
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  5. Tae-Joon Cho MD
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Correspondence to Moon Seok Park MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Lee, S.H., Chung, C.Y., Park, M.S. et al. Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement. Clin Orthop Relat Res 467, 2098–2104 (2009). https://doi.org/10.1007/s11999-009-0705-1

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  • DOI: https://doi.org/10.1007/s11999-009-0705-1

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