Measuring Lower Extremity Rotational Alignment: A Review of Methods and Case Studies of Clinical Applications

➣ Underdetection and undertreatment of transverse plane malalignment of the tibia and femur result from challenges with accuracy and reliability of both physical examination and imaging. ➣ Excessive femoral and tibial torsion both impair joint moment generation, with potential adverse effects on joint health directly as well as indirectly as a result of gait compensation. ➣ Static computed tomography measurements of rotational alignment are limited by variable reference axes, expense, radiation exposure, and inability to measure dynamic compensation, and to date they have not been applicable intraoperatively. ➣ Kinematics derived from functional modeling in 3-dimensional (3D) gait analysis provide subject-specific data and can detect not only static but also functional alignment. ➣ The use of 3D data generated by EOS radiography holds promise for assessing biplanar limb alignment.