Ki Hyuk Sung, MD

Relationship between rotational gait parameters and torsional bony

deformities in patients with diplegic cerebral palsy

Seoul National University Bundang Hospital

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Introduction

• Intoeing gait is a common gait problem in patients with diplegic CP, which affects gait efficacy and cosmesis.

• Femoral anteversion and tibial torsion are usually focuses of attention in evaluation and treatment.

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Introduction

• However, there might be other structural problem affecting rotational gait parameters.

• In some clinical situation, degree of femoral anteversion and tibial torsion do not necessarily reflect the severity of the rotational gait problems.

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Purpose of the study

• To investigate comprehensively relationships between rotational gait parameters and torsional bony alignment, including different deformity types, in patients with diplegic CP

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Materials and Methods

• Retrospective design

• Inclusion

– Ambulatory patients with diplegic CP

– 3D gait analysis

– Torsional CT

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3D gait parameters

• Mean foot progression angle in stance

• Mean hip rotation

• Mean tibia rotation

• Mean pelvic rotation

• Adjusted foot progression angle

– Foot progression angle – pelvic rotation

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Radiographic measurements

• Acetabular version on CT

• Femoral anteversion on CT

• Tibial torsion on CT

• Knee torsion on CT

• AP talo-1st metatarsal angle on

weightbearing AP foot radiographs

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Acetabular version

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Femoral anteversion

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Knee torsion

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Tibial torsion

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AP talo-1st metatarsal angle

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Reliability of radiographic measurement

• 2 orthopaedic surgeons, 15 patients

• ICC (intraclass correlation coefficient)

& MAD (mean absolute difference)

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Relation btw radiographic measurements & gait parameters

• Pearson’s correlation coefficient

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Multiple regression anlysis

• Structural torsional deformities (CT and

radiographic measurements) significantly

contributing to adjusted foot progression

angle

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Results

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Conclusions

• Adjusted foot pregression angle was more

relevant than foot progression angle.

• Femoral anteversion and tibial torsion

were found to be the significant structural

deformities that affect adjusted foot

progression angle

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Conclusions

• However, femoral anteversion and tibial

torsion were found to explain only 24.7%

of adjusted foot progression angle

• Other structural factors or muscle balance

need to be considered.

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Thank you !