Internal Torsion Research Articles

Double-Level Torsional Osteotomy in Severe Torsional Malalignment: A Surgical Technique

Background: Torsional malalignment of the femur and/or tibia is associated with patellar maltracking, and torsional osteotomies have shown to improve clinical symptoms. In patients with severe torsional malalignment, a double-level torsional osteotomy may be necessary. Indications: Symptomatic torsional malalignment leading to patellofemoral maltracking associated with anterior knee pain and/or patellofemoral instability. Technique Description: A double-level torsional osteotomy correcting both increased internal femoral torsion and increased external tibial torsion, is described. Meticulous preoperative deformity analysis and planning of the osteotomy is mandatory. An arthroscopy of the knee is performed first to evaluate the patellofemoral joint and patellar tracking. Tibial torsional correction is performed by a lateral approach. A biplanar osteotomy is performed, and the amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis can be done via a bended 5-hole DC-Plate or an angle-stable plate. The femoral osteotomy is performed by a medial approach. A uniplanar osteotomy is performed perpendicular to the mechanical axis of the femur. The amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis is achieved by an angle-stable plate. Results: Double-level torsional osteotomy has been shown to be an effective treatment for patients with patellar dislocation or subluxation associated with severe torsional malalignment. In a series of 18 patients, double-level osteotomy led to improved patellofemoral stability, decreased pain, and increases subjective outcome scores. Discussion/Conclusion: In patients with patellofemoral problems caused by a combined increased tibial external torsion and increased femoral internal torsion, a double-level torsional osteotomy is able to correct torsional angles to normal. Available clinical data on this procedure are promising. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Theoretical and FEA investigation of the mechanical behaviour for offshore LCO2 floating hose

Injecting liquid CO2 (LCO2) into the seabed for storage utilizing an offshore platform to achieve offshore storage of CO2 is one of the effective measures to realize the reduction of CO2 emissions. To solve the difference in motion characteristics between the LCO2 carrier and the receiving platform due to wind and wave currents, floating hoses can be employed as the pipeline in the CO2 transportation. In this study, an LCO2 floating hose based on the structural form of steel wire reinforced thermoplastic composite pipe is proposed. A mechanical model for this hose is developed to analyze the tensile mechanical properties. It is verified that the method is reliable by comparing with the published experimental results of composite hose containing 4 layers of aramid fiber reinforced layers with a maximum error of 11.48%. A comparative analysis was also carried out by finite element analysis (FEA) with a maximum error of 10.67%. On this basis, the damage states of the hose under internal pressure, tension, bending and torsion load were investigated to analyze mechanical properties. The ultimate tensile load capacity, ultimate bending radius and ultimate unit torsion angle are 463 kN, 1.64m and 14°/m, respectively. The components most prone to failure under different loads were clarified. This study can provide technical reference for the design of floating hoses for offshore LCO2 storage and transportation.

Impact of foot progression angle on spatiotemporal and plantar loading pattern in intoeing children during gait

Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.

Analysis of load carrying performance for glass fiber reinforced thermoplastic composite pipe under different in-service conditions

Fiber reinforced thermoplastic composite pipe (FRTP) has advantages over traditional metallic counterparts for oil and gas transportation. During in-service the pipe is subjected to different mechanical loads including internal pressure, torsion, and bending. In this work, a special type of continuous glass fiber reinforced thermoplastic composite pipe (DN150-6.4 MPa) is analyzed by finite element method (FEM) under various complex service-in conditions. Stress and strain are investigated for different layers of FRTP to determine the extreme load capacity. Experimental analysis is conducted to validate proposed method. Combining the results from FEM and test, it is concluded that the ultimate internal pressure (burst pressure) of FRTP is 61.7 MPa, the ultimate axial tensile displacement is 66.4 mm, the maximum torsion angle is 71.5°, and the minimum bending radius 978.9 mm. Under different working conditions, the mechanical properties of the FRTP are still surplus under the given load. For the good agreement with experimental data, the FEM modeling can be guide for practical application of FRTP.

Failure factor of reinforced layer for fiber-wound composite pipe under different loads

This study examined the failure mechanism of fiber-wound composite pipe and determined the optimum winding angle. Simulation models of glass fiber-wound composite pipe were established. Failure factor of the reinforced layer of fiber-wound composite pipes under internal pressure, torsion, axial tension and bending load are investigated in conjunction with the three-dimensional Tsai-Wu failure criterion. The results show that the winding angle has a significant effect on the stress distribution of the reinforced layer. The inner layer of the reinforced layer is prone to failure under internal pressure. The outer layer of reinforcement layer under torsion is the easy failure position. The failure-prone layer under tensile load is related to the winding angle. The inner layer of the reinforced layer is prone to failure when the winding angle is less than 60°, and the outer layer is prone to failure when the winding angle is more than 60°. The outer reinforced layer is prone to failure under bending loads. When the winding angle is less than 50°, the easily failed failure position is on the inside of bending. When the winding angle is greater than 50°, the easily failed position is on the outside of bending. The smaller winding angle is conducive to improve the tensile, bending and torsion resistance of the composite pipe. The larger winding angle is beneficial for improving resistance to internal pressure. The optimal winding angle range for each load is different and multiple winding angles should be used in the design to obtain a higher overall load carrying capacity. The research results can provide a theoretical basis for the improved design, manufacture and evaluation of fiber-wound composite pipes.

Exploring torsional conformer space with physical prior mean function-driven meta-Gaussian processes.

We present a novel approach for systematically exploring the conformational space of small molecules with multiple internal torsions. Identifying unique conformers through a systematic conformational search is important for obtaining accurate thermodynamic functions (e.g., free energy), encompassing contributions from the ensemble of all local minima. Traditional geometry optimizers focus on one structure at a time, lacking transferability from the local potential-energy surface (PES) around a specific minimum to optimize other conformers. In this work, we introduce a physics-driven meta-Gaussian processes (meta-GPs) method that not only enables efficient exploration of target PES for locating local minima but, critically, incorporates physical surrogates that can be applied universally across the optimization of all conformers of the same molecule. Meta-GPs construct surrogate PESs based on the optimization history of prior conformers, dynamically selecting the most suitable prior mean function (representing prior knowledge in Bayesian learning) as a function of the optimization progress. We systematically benchmarked the performance of multiple GP variants for brute-force conformational search of amino acids. Our findings highlight the superior performance of meta-GPs in terms of efficiency, comprehensiveness of conformer discovery, and the distribution of conformers compared to conventional non-surrogate optimizers and other non-meta-GPs. Furthermore, we demonstrate that by concurrently optimizing, training GPs on the fly, and learning PESs, meta-GPs exhibit the capacity to generate high-quality PESs in the torsional space without extensive training data. This represents a promising avenue for physics-based transfer learning via meta-GPs with adaptive priors in exploring torsional conformer space.

Different Modalities in Management of Recurrent Patellar Dislocation

Background Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this entity is multifactorial, and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. Objective To review the currently available different modalities for management of recurrent patellar dislocation. This Review will analyze results concerned with Patellar instability to reach the most efficient modality that gives the best results. Material and Methods This systematic review study based on inclusion and exclusion criteria conducted to evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications. This systematic review demonstrates that MPFL surgery for recurrent patellar dislocation isolated or in combination with other procedures results in a significant improvement in Kujala scores, a low redislocation rate, and an acceptable complication rate. Despite this, there is no consensus on indications for MPFL reconstruction, graft type, surgical technique, and rehabilitation program. The inclusion criteria for future studies were highly important, and consensus agreement within an expert panel should be sought prior to undertaking such a study. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Results Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. This short-term study showed that after MPFL reconstruction (suture anchors or transosseous sutures), patellar stability could be restored. And no significant differences in outcome scores were observed between patients in the transosseous suture and suture anchor groups. Conclusion Evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications.

A PROSPECTIVE STUDY OF TREATMENT OF IDIOPATHIC CLUBFOOT (CTEV) USING PONSETI METHOD

Background: Congenital talipes equina varus (CTEV) or clubfoot is one of the commonest orthopedic problems seen in infants. CTEV is the term used to describe as a deformity involving in utero malalignment of the calcaneo-talar-navicular complex of the foot. The incidence is 1 in 1000 live births with male to female ratio is 3:1 and is bilateral in 50% of the infants. Idiopathic congenital talipes equinovarus (clubfoot) is a complex deformity that is difcult to correct. The deformity has four components - cavus, adductus, varus equinus and internal tibial torsion. The goal of treatment is to reduce or eliminate these deformities so that the patient has a functional pain-free foot with good mobility and does not need to wear modied shoes. Most orthopaedic surgeons agree that the initial treatment should be non-surgical and should start as soon as possible after birth. Many methods have been described, most of which involve serial manipulation and casting. If left untreated, clubfoot inevitably leads to signicant long-term disability, deformity and pain. Although various surgical techniques are used to correct clubfoot, such as soft tissue releases or bony procedures in older children, currently, conservative management is the preferred option in infants. The technique of gradual and simultaneous correction of all deformities of CTEV using manipulation and casting at weekly interval described by Dr.Ignacio V. Ponseti has gained wide acceptance throughout the world. In this study, we have attempted to analyse the functional outcome of Idiopathic clubfoot using Ponseti's technique in children. To study the outcome following the use of Ponseti technique Objectives: for idiopathic clubfoot. To evaluate the efcacy of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot. Children with congenital Source Of Data: idiopathic clubfoot consulted at Basaweshwar teaching and general hospital; attached to Mahadevappa Rampure Medical College, Kalaburagi. Method Of Collection Of Data: The study proposes to include patients with congenital clubfoot examined according to the protocol. Associated deformities are noted.The severity of foot deformity was assessed according to Pirani scoring system before and after treatment.Serial toe to groin castings will be applied. The number of casts required to obtain correction and the need for tenotomy was also recorded. Patients will be reviewed at weekly intervals till all deformities except equinus are corrected and once in a month following tenotomy and the use of orthotics. Results: Average number of cast applied before equinus correction in 0-6month age group was 6.3 and 7-12month age group was 6.7 average number ofnal cast used in 0-6months of age was 7.3 and in 7-12months it was 7.7 .Average number of cast increases with increase in age and Pirani severity score 98% of patient had no residual deformity at the time of follow up 2% had relapse at the time of nal follow up. There was a signicant reduction in the PSS after each cast and these difference in PSS between before equinus correction and after the last cast were signicant with the p value of <0.001. Ponseti technique of treatment for Clubfoot deformity is very effective, a Interpretation / Conclusion: nd produces painless, mobile, exible, plantigrade and cosmetically acceptable foot without need of any major surgical intervention

Molecular Identification from AFM Images Using the IUPAC Nomenclature and Attribute Multimodal Recurrent Neural Networks.

Spectroscopic methods─like nuclear magnetic resonance, mass spectrometry, X-ray diffraction, and UV/visible spectroscopies─applied to molecular ensembles have so far been the workhorse for molecular identification. Here, we propose a radically different chemical characterization approach, based on the ability of noncontact atomic force microscopy with metal tips functionalized with a CO molecule at the tip apex (referred as HR-AFM) to resolve the internal structure of individual molecules. Our work demonstrates that a stack of constant-height HR-AFM images carries enough chemical information for a complete identification (structure and composition) of quasiplanar organic molecules, and that this information can be retrieved using machine learning techniques that are able to disentangle the contribution of chemical composition, bond topology, and internal torsion of the molecule to the HR-AFM contrast. In particular, we exploit multimodal recurrent neural networks (M-RNN) that combine convolutional neural networks for image analysis and recurrent neural networks to deal with language processing, to formulate the molecular identification as an imaging captioning problem. The algorithm is trained using a data set─which contains almost 700,000 molecules and 165 million theoretical AFM images─to produce as final output the IUPAC name of the imaged molecule. Our extensive test with theoretical images and a few experimental ones shows the potential of deep learning algorithms in the automatic identification of molecular compounds by AFM. This achievement supports the development of on-surface synthesis and overcomes some limitations of spectroscopic methods in traditional solution-based synthesis.

Hip Pain after Distal Femoral Derotational Osteotomy for a Patient with Patellar Instability: A Case Report

Increased torsional deformity of femur is one of the most important factors in recurrent patellofemoral instability. And distal femoral derotational osteotomy is an effective treatment option in patients with increased femoral torsional deformity. However, groin pain is a rare complication after femoral derotational osteotomy. The patient was a 23-year-old female suffering from anterior knee pain and patellar instability in her left leg. Continuous CT scans of the hip, knee, and ankle were performed and the femoral anteversion was 44.99°. Considering the significant enlargement of the femoral internal torsion which may contribute most for dislocation of patella, we did a derotational osteotomy of distal femur. The anterior knee pain and patellar instability were resolved after surgery. The femoral internal torsion angle was corrected to 21.47°. But she developed left hip pain in the groin area which she had never encountered before 1 year after the surgery. We believed that the hip pain was closely related to the surgery. And the imaging and follow-up partly confirmed this. The situation of the hip joint should be carefully evaluated before doing derotational osteotomy in recurrent patellofemoral instability and patient should be informed that derotational osteotomy may cause hip pain. Clinical studies are needed to further clarify the impact of derotational osteotomy on the hip.

The biomechanical effect of fibular strut grafts on humeral surgical neck fractures with lateral wall comminution

No studies have evaluated the effect of fibular strut augmentation on the stability of locking plate fixation for osteoporotic proximal humeral fractures with lateral wall comminution. The purpose of this study was to evaluate the stability of locking plate fixation with a fibular strut graft compared with locking plate alone in an osteoporotic two-part surgical neck fracture model with lateral cortex comminution. Ten paired fresh-frozen cadaveric humeri were randomly allocated into two groups, either the locking plate alone (LP group) or locking plate with fibular strut graft augmentation (LPFSG group), with an equal number of right and left osteoporotic surgical neck fractures with lateral wall comminution of the greater tuberosity. Varus, internal/external torsion, and axial compression stiffness as well as single load to failure were measured in plate-bone constructs, and the LPFSG group showed significantly greater values in all metrics. In conclusion, this biomechanical study shows that fibular strut augmentation significantly enhances varus stiffness, internal torsion stiffness, external torsion stiffness, and maximum failure load of a construct compared to locking plate fixation alone in proximal humeral fractures with lateral wall comminution.

Local torsion of distal femur is a risk factor for patellar dislocation

PurposeIt has been widely reported that femoral anteversion is a risk factor for patellar dislocation. This study aims to evaluate whether internal torsion of the distal femur is noticeable in patients without increased femoral anteversion and to assess whether it is a risk factor for patellar dislocation.MethodsA retrospective analysis was conducted on 35 patients (24 females, 11 males) with recurrent patellar dislocation but without increased femoral anteversion treated in our hospital from January 2019 to August 2020. All patients underwent knee X-rays, digital radiography of lower-limbs, and CT scans of hip, knee, and ankle joints to measure femoral anteversion angle, distal femoral torsion angle, TT–TG and Caton-Deschamps index. Thirty-five control cases were matched on age and sex to compare the difference of anatomic parameters between the two groups, and the logistic analysis was used to analyze risk factors for patellar dislocation. Perman correlation coefficient was used to evaluate the correlation among femoral anteversion, distal femoral torsion and TT–TG.ResultsGreater distal femoral torsion was still observed in patients with patellar dislocation but without increased femoral anteversion. The torsion angle of distal femur, TT–TG distance and incidence of Patella Alta in patients with patellar dislocation were greater than those in control group, and the inter-group differences were statistically significant (P < 0.05). The torsion angle of distal femur (OR = 2.848, P < 0.001), TT–TG distance (OR = 1.163, P = 0.021) and Patella Alta (OR = 3.545, P = 0.034) were risk factors for patellar dislocation. However, no significant correlation was found among femoral anteversion, distal femoral torsion and TT–TG in patients with patellar dislocation.ConclusionOn the condition that femoral anteversion did not increase, increased distal femoral torsion was commonly observed in patients with patellar dislocation, which represents an independent risk factor for patellar dislocation.

Asymmetric rotations and dimerization driven by normal to modulated phase transition in 4-biphenylcarboxy coupled L-phenylalaninate.

Amongst the derivatives of 4-biphenylcarboxylic acid and amino acid esters, the crystal structure of 4-biphenylcarboxy-(L)-phenylalaninate is unusual owing to its monoclinic symmetry within a pseudo-orthorhombic crystal system. The distortion is described by a disparate rotational property around the chiral centers (ϕchiral ≃ -129° and 58°) of the two molecules in the asymmetric unit. Each of these molecules comprises planar biphenyl moieties (ϕbiphenyl = 0°). Using temperature-dependent single-crystal X-ray diffraction experiments we show that the compound undergoes a phase transition below T ∼ 124 K that is characterized by a commensurate modulation wavevector, q = δ(101), δ = ½. The (3+1)-dimensional modulated structure at T = 100 K suggests that the phase transition drives the biphenyl moieties towards noncoplanar conformations with significant variation of internal torsion angle (ϕmaxbiphenyl ≤ 20°). These intramolecular rotations lead to dimerization of the molecular stacks that are described predominantly by distortions in intermolecular tilts (θmax ≤ 20°) and small variations in intermolecular distances (Δdmax ≃ 0.05 Å) between biphenyl molecules. Atypical of modulated structures and superstructures of biphenyl and other polyphenyls, the rotations of individual molecules are asymmetric (Δϕbiphenyl ≈ 5°) while ϕbiphenyl of one independent molecule is two to four times larger than the other. Crystal-chemical analysis and phase relations in superspace suggest multiple competing factors involving intramolecular steric factors, intermolecular H-C...C-H contacts and weak C-H...O hydrogen bonds that govern the distinctively unequal torsional properties of the molecules.

Determination of Standard Values for Knee Version in a Healthy Population

Background: Different measures are used to describe relevant anatomic variations that can result in patellofemoral instability and disorders. Knee version, the relative rotational alignment between the femur and tibia in the axial plane at the level of the knee, may have a decisive effect on the kinematics of the patellofemoral joint. However, data regarding the values of knee version are currently lacking. Purpose: This study aimed to determine standard values for knee version in a healthy population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 100 healthy volunteers (50 male and 50 female) without patellofemoral disorders or lower extremity malalignment were included in this study and underwent knee magnetic resonance imaging. The torsion values of the femur and tibia were independently measured using the Waidelich and Strecker method. Knee version, defined as static rotation of the tibia with respect to the femur in full extension, was determined by measuring the angle between the tangent lines to the dorsal femoral condyle (DFC) and the dorsal tibial head (DTH; defined by the posterior point of the proximal tibial plateau). Supplementary measurements were obtained as follows: (1) femoral epicondylar line (FEL), (2) tibial ellipse center line (TECL), (3) tibial tuberosity–trochlear groove (TT-TG) distance, and (4) tibial tuberosity–posterior cruciate ligament (TT-PCL) distance. Results: In 200 analyzed legs of 100 volunteers (mean age, 26.5 ± 5.8 years [range, 18 to 40 years]), we identified a mean internal femoral torsion of −23.8°± 9.7° (range, −46.2° to 1.6°), external tibial torsion of 33.2°± 7.4° (range, 16.4° to 50.3°), and external knee version (DFC to DTH) of 1.3°± 3.9° (range, −8.7° to 11.7°). Other measurements were as follows: FEL to TECL, −0.9°± 4.9° (range, −16.8° to 12.1°); FEL to DTH, −3.6°± 4.0° (range, −12.6° to 6.8°); and DFC to TECL, 4.0°± 4.9° (range, −12.7° to 14.7°). The mean TT-TG distance was 13.4 ± 3.7 mm (range, 5.3-23.5 mm), and the mean TT-PCL distance was 11.5 ± 3.5 mm (range, 6.0-20.9 mm). Female participants had significantly greater external knee version than male participants. Conclusion: Coronal- and sagittal-plane alignments of the knee have a well-known effect on the biomechanics of this joint. Additional information about the axial plane may result in new decision-making algorithms for managing knee disorders. This study is the first to report standard values of knee version in a healthy population. As a subsequent step building on this work, we advocate for the measurement of knee version in patients with patellofemoral disorders, as this parameter may assist with new treatment guidelines in the future.

ACES: Optimized Alchemically Enhanced Sampling.

We present an alchemical enhanced sampling (ACES) method implemented in the GPU-accelerated AMBER free energy MD engine. The methods hinges on the creation of an "enhanced sampling state" by reducing or eliminating selected potential energy terms and interactions that lead to kinetic traps and conformational barriers while maintaining those terms that curtail the need to otherwise sample large volumes of phase space. For example, the enhanced sampling state might involve transforming regions of a ligand and/or protein side chain into a noninteracting "dummy state" with internal electrostatics and torsion angle terms turned off. The enhanced sampling state is connected to a real-state end point through a Hamiltonian replica exchange (HREMD) framework that is facilitated by newly developed alchemical transformation pathways and smoothstep softcore potentials. This creates a counterdiffusion of real and enhanced-sampling states along the HREMD network. The effect of a differential response of the environment to the real and enhanced-sampling states is minimized by leveraging the dual topology framework in AMBER to construct a counterbalancing HREMD network in the opposite alchemical direction with the same (or similar) real and enhanced sampling states at inverted end points. The method has been demonstrated in a series of test cases of increasing complexity where traditional MD, and in several cases alternative REST2-like enhanced sampling methods, are shown to fail. The hydration free energy for acetic acid was shown to be independent of the starting conformation, and the values for four additional edge case molecules from the FreeSolv database were shown to have a significantly closer agreement with experiment using ACES. The method was further able to handle different rotamer states in a Cdk2 ligand identified as fractionally occupied in crystal structures. Finally, ACES was applied to T4-lysozyme and demonstrated that the side chain distribution of V111χ1 could be reliably reproduced for the apo state, bound to p-xylene, and in p-xylene→ benzene transformations. In these cases, the ACES method is shown to be highly robust and superior to a REST2-like enhanced sampling implementation alone.

Evaluation of Q Angle in Down syndrome

Background: Down Syndrome is a genetic disorder and the most common chromosomal abnormality. It is predominantly characterized by muscle hypotonia and joint hypermobility. Qangle is the angle formed between two imaginary lines one from ASIS to Center of Patella, another from Tibial tuberosity to the Center of Patella. Objectives: Aim of the study is to evaluate the Q-angle in male children with Down syndrome of 7-16 years of age and compare the values between children with internal and external tibial torsion. Methodology: It is an observational study done with convenient sampling carried out in 12 male children with Down syndrome. The tibial torsion was measured. Based on internal and external tibial torsion they were categorized into Group A and B respectively. Group A consisting of 7 children with internal tibial torsion and Group B consisting of 5 children with external tibial torsion. Q-angle was measured using standard goniometer. Results: There is no significant difference in P-value (P&gt;0.05) between the right and left leg of children in Group A and in Group B. On comparison between Group A and Group B, there was a statistical significance in P-Value of 0.005 and 0.050 when compared mean of Q angle for right leg and left leg respectively. Conclusion: The study concluded that assessing Q-angle helps to evaluate the biomechanical changes in knee. In this study done for the male children with Down syndrome, the Q-angle lies within the normal range of 13.1±3.5. However children with internal tibial torsion has comparatively decreased angle and children with external tibial torsion has comparatively increased angle even though there is no deviation from the normal range for the age.

Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra-articular internal tibial rotation in ACL-deficient knees based on magnetic resonance imaging

PurposeThe purpose of the present study was to assess the internal rotation of the tibia on Magnetic Resonance Imaging (MRI) in a series of consecutive athletes with Anterior cruciate Ligament (ACL) tears.MethodsRetrospective analysis of prospectively collected data was performed to include all consecutive patients who had undergone primary ACL reconstruction between January 2022 and June 2022. The angle between surgical epicondylar axes (SEA) of the knee and posterior tibial condyles (PTC) was measured. A negative value was defined as internal torsion. KFs and ALL injuries were reported. Analysis of covariance (ANCOVA) was performed to examine the independent associations between SEA-PTC angle and injuries of KFs and ALL adjusted for physical variables (age, gender and body mass index [BMI]). Statistical significance was set at a p-value of < 0.05.ResultsA total of 83 eligible patients were included. The result of multiple linear regression analysis showed that internal tibial rotation was associated with KFs and ALL injuries. The estimated average of SEA-PTC angle in relation to ALL injuries controlling the other variables was -5.49 [95%CI -6.79 – (-4.18)] versus -2.99 [95%CI -4.55 – (-1.44)] without ALL injuries. On the other hand, the estimated average of SEA-PTC angle in relation to KFs lesions controlling the other variables was -5.73 [95%CI -7.04 – (-4.43)] versus -2.75 [95%CI -4.31 – (-1.18)] without KFs injuries.ConclusionsKFs and ALL injuries were associated with an increased intra-articular internal tibial rotation in ACL-deficient knees. The measurement of femorotibial rotation on axial MRI could be useful to detect indirect signs of anterolateral complex (ALC) injuries.

CORRECTION OF ADOLESCENT BLOUNT`S DISEASE DEFORMITY USING ILIZAROV FRAME A CASE REPORT.

Introduction- Blount's disease is dened as a growth disorder of medial aspect of proximal tibia physis with abrupt medial angulation of proximal tibia distal to epiphysis, leading to varus angulation of proximal tibia and medial rotation of tibia. Epidemiology is not well established and very rarely cases have been reported from Indian subcontinent. It is associated with internal tibial torsion and genu recurvatum. The aim of Objective: this work to evaluate the results of acute correction of adolescent Blount's disease using ilizarov frame constructed for gradual correction taking the benets of acute correction. A 16 year old male adolescent presented with Presentation Of Case- deformity in right foot and altered walking pattern for past 2 years . On examination there was 13 degrees varus deformity in right leg. There was a 15 degree internal tibial rotation on right side. Knee range of motion was 10 degree of hyperextention to 140 degree of full exion. Patient managed by surgical intervention. oblique proximal osteotomy was done. deformity correction was done by ilizarov frame. patient recovered well with correction of deformity and could walk with normal gait pattern. Patient result were assessed both cli Results- nically and radiological .Restoration of mechanical axis ,knee range of movement, weight bearing, range of motion [ROM] external xator time and possible complications were assessed. The average external xator time was 12 weeks. Blount's disease is a very rarely encountered condition in Conclusion- Indian subcontinent but has a characteristic presentation. We conclude that acute correction of adolescent Blount`s disease using a frame constructed for gradual correction is a safe and reliable technique. It combines the benets of both acute and gradual correction allowing for shorter healing time and to correct any operative error at the clinic and reducing the need for intraoperative uoroscopy.

Internal tibial torsion is associated with medial meniscus posterior horn tears.

Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. III.

Three-dimensional volume rendering planning, surgical treatment, and clinical outcomes for femoral and tibial detorsional osteotomies in dogs.

To describe a computed tomographic (CT) methodology for planning the correction of femoral and tibial torsion and report the clinical outcomes after femoral (FDO) and tibial (TDO) detorsional osteotomy in dogs affected by torsion malalignment and patellar luxation (PL). Multicenter retrospective study. Eighteen client-owned dogs. Dogs underwent CT to measure femoral (FTA) and tibial torsion angle (TTA). Abnormal femoral external torsion was defined when FTA <20°, abnormal femoral internal torsion if FTA >35°; abnormal tibial external torsion was defined when TTA < -10°, and abnormal tibial internal torsion when TTA >2°. The cortical arch length (CAL) was measured with CT and used intraoperatively to determine the magnitude of correction. The medical records and radiographs were reviewed and used to report clinical and radiographic outcomes. Radiographs were reviewed to evaluate postoperative limb alignment, patellar position, and bone healing. Twenty-two detorsional osteotomies were performed. Mean preoperative FTA was 14° for medial-PL and 45.2° for lateral-PL. Mean preoperative TTA was 11° for medial-PL. Physiological patellar tracking was restored in 22/22 of cases. CAL measurement allowed for correction of abnormal torsion in 19/22 of cases. Seventeen out 18 dogs had full or acceptable functional outcome. The median radiographic follow-up was 3months. Major complications occurred in 2/22 cases, which suffered an iatrogenic abnormal femoral internal torsion and a persistent hindlimb lameness. CAL can be measured with CT and used intraoperatively to guide the correction of abnormal torsion in dogs. Abnormal femoral and tibial torsion are predisposing factors for PL. A higher complication rate is expected when FDO and TDO are performed in the same hindlimb.