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<p>This article presents a&#xa0;diagnostic and therapeutic algorithm for distal tibial derotational osteotomy, illustrated by a&#xa0;case of torsional malalignment syndrome. The increased external tibial torsion typically requires treatment in the context of torsional malalignment syndrome with anterior knee pain or patellar instability. The diagnostic work-up includes a&#xa0;thorough clinical examination (gait assessment and rotational profile), conventional radiographs, rotation analysis of the by magnetic resonance imaging (MRI) and full-length standing radiographs of the leg to comprehensively evaluate tibial and femoral torsion and coronal alignment. In most cases, the initial management consists of targeted muscle strengthening under physiotherapeutic supervision. Surgical correction of tibial torsion is part of a&#xa0;multifactorial treatment and strategy addressing anterior knee pain or patellar instability. A comprehensive analysis of all contributing factors, e.g., femoral torsion, knee version, tibial tuberosity-trochlear groove (TT–TG) distance and gait pattern, is critical for determining the indications for surgery and the degree of correction required. As a&#xa0;general guideline, a symptomatic external tibial torsion exceeding 35° (angle between the transmalleolar axis above the ankle joint and the tangent of the posterior tibial condyle below the knee joint line), warrants consideration for a surgical intervention, with correction angles typically 10–25°, individualized to restore normal kinematics and gait while minimizing the risk of overcorrection. We advocate distal tibial derotational osteotomy as the standard technique due to its favorable bone healing potential, low risks (including compartment syndrome and nerve injury) and reliable surgical reproducibility. Proximal tibial osteotomy is reserved for cases necessitating simultaneous correction of a&#xa0;pathologically increased and clinically significant TT–TG distance or additional coronal deformity.</p>

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Distale tibiale Torsionsosteotomie – Algorithmus von konservativ bis operativ

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月4日

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  • Timo Tondelli,
  • Tilman Garthe,
  • Jan-Arie Overberg,
  • Florian B. Imhoff

摘要

This article presents a diagnostic and therapeutic algorithm for distal tibial derotational osteotomy, illustrated by a case of torsional malalignment syndrome. The increased external tibial torsion typically requires treatment in the context of torsional malalignment syndrome with anterior knee pain or patellar instability. The diagnostic work-up includes a thorough clinical examination (gait assessment and rotational profile), conventional radiographs, rotation analysis of the by magnetic resonance imaging (MRI) and full-length standing radiographs of the leg to comprehensively evaluate tibial and femoral torsion and coronal alignment. In most cases, the initial management consists of targeted muscle strengthening under physiotherapeutic supervision. Surgical correction of tibial torsion is part of a multifactorial treatment and strategy addressing anterior knee pain or patellar instability. A comprehensive analysis of all contributing factors, e.g., femoral torsion, knee version, tibial tuberosity-trochlear groove (TT–TG) distance and gait pattern, is critical for determining the indications for surgery and the degree of correction required. As a general guideline, a symptomatic external tibial torsion exceeding 35° (angle between the transmalleolar axis above the ankle joint and the tangent of the posterior tibial condyle below the knee joint line), warrants consideration for a surgical intervention, with correction angles typically 10–25°, individualized to restore normal kinematics and gait while minimizing the risk of overcorrection. We advocate distal tibial derotational osteotomy as the standard technique due to its favorable bone healing potential, low risks (including compartment syndrome and nerve injury) and reliable surgical reproducibility. Proximal tibial osteotomy is reserved for cases necessitating simultaneous correction of a pathologically increased and clinically significant TT–TG distance or additional coronal deformity.