Can a turning inwards patella predict an excess of femoral anteversion?

Abstract

Introduction: In children with spastic diplegia, a turning inwards patella during gait is often considered to be related to an excess of femoral anteversion. The aim of our studywas to investigate the relationship of these two parameters during gait. Patients/materials andmethods:We retrospectively reviewed the charts of 188 children with spastic diplegia. One hundred three of them showed a turning inwards patella during gait (206 lower limbs). Data collected were: hip range of motion, femoral anteversion, spasticity and tightness of internal rotators, patella orientation, hip and pelvis kinematics at mid stance. Results: One hundred forty nine lower limbs showed excess of femoral anteversion (72%). Among patients with excessive femoral anteversion, only 66 had kinematic internal hip rotation. Other causes were: internal pelvic rotation, isolated spasticity and/or retraction of medial rotator muscles. Discussion and conclusions: Observational gait analysis was not sufficient to identify pelvic rotational troubles. The lack of kinematic data could conduct to amisinterpretation of turning inwards patella gait. Turning inwards patella during gait does not necessarily mean excessive femoral anteversion and excessive femoral anteversion does not necessarily result in turning inwards patella gait. 3D gait analysis is an essential tool to complete physical examination. It should help therapeutic decisions and limit the errors in diagnosis.