A comparison of four in vivo methods of measuring tibial torsion

Tibial torsion, twisting of the tibia about its longitudinal axis, varies during development and early childhood. Knowledge of the normal range of tibial torsion at various ages and its accurate clinical measurement is important in the assessment of the extent of a torsional deformity. To evaluate tibial torsion a reliable technique for its measurement in vivo is therefore required. The aim of this study was to determine which of 4 existing in vivo methods of measuring tibial torsion was the most accurate and had the highest repeatability, by comparing them with direct measurement of the tibia. A wide range of mean values for tibial torsion was observed, using the various techniques, with none of the indirect techniques employed having a strong correlation with direct measurement of tibial torsion. The repeatability of the indirect techniques was observed to be low both in cadavers (n=4) and the living (n=3). Since none of the in vivo techniques appear to measure true tibial torsion or be of a reasonable repeatability, alternative easy to use and inexpensive methods need to be developed. Accurate clinical measurement of tibial torsion is important in the assessment of the extent of a torsional deformity. It is recommended that data gained using the methods reviewed here are interpreted with caution.