{"title":"A medial malleolus marker provides precise measurements of tibial torsion that align closely with EOS","authors":"Patrick Do, Jing Feng, Ellen M. Raney","doi":"10.1016/j.clinbiomech.2025.106591","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Tibial malalignment often occurs in children with neurological and musculoskeletal disorders like cerebral palsy. Tibial torsion measurement, crucial for treatment decisions, is typically assessed using the conventional gait model, which places markers on the lateral shank, knee, and malleolus. However, accurately placing these markers can be challenging. Studies suggest adding a medial malleolus marker improves measurement accuracy. Additionally, EOS imaging provides a low-radiation, cost-effective method for measuring tibial rotation. This study aimed to evaluate the accuracy of the conventional gait model versus the medial malleoli marker method, compare these with passive goniometer measurements, and correlate results with EOS imaging.</div></div><div><h3>Methods</h3><div>In a cohort of 31 participants (aged 5–17 years), tibial torsion was assessed through physical exams, gait analysis, and EOS imaging. Tibial rotation was analyzed using the conventional model and medial malleoli marker method. Correlations between methods were assessed using Pearson's coefficient and Bland-Altman plots.</div></div><div><h3>Findings</h3><div>The medial malleoli marker method correlated more strongly with EOS imaging (<em>r</em> = 0.66) than the conventional model (<em>r</em> = 0.27). It also showed excellent agreement with passive goniometer measurements (<em>r</em> = 0.92). EOS imaging consistently reported higher torsion values compared to other methods.</div></div><div><h3>Interpretation</h3><div>Adding a medial malleolus marker enhances the accuracy and reliability of tibial rotation measurements compared to the conventional gait model. While discrepancies exist with EOS imaging, the medial malleoli marker method shows stronger alignment with both passive and imaging-based assessments.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"127 ","pages":"Article 106591"},"PeriodicalIF":1.4000,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Biomechanics","FirstCategoryId":"5","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0268003325001640","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Tibial malalignment often occurs in children with neurological and musculoskeletal disorders like cerebral palsy. Tibial torsion measurement, crucial for treatment decisions, is typically assessed using the conventional gait model, which places markers on the lateral shank, knee, and malleolus. However, accurately placing these markers can be challenging. Studies suggest adding a medial malleolus marker improves measurement accuracy. Additionally, EOS imaging provides a low-radiation, cost-effective method for measuring tibial rotation. This study aimed to evaluate the accuracy of the conventional gait model versus the medial malleoli marker method, compare these with passive goniometer measurements, and correlate results with EOS imaging.
Methods
In a cohort of 31 participants (aged 5–17 years), tibial torsion was assessed through physical exams, gait analysis, and EOS imaging. Tibial rotation was analyzed using the conventional model and medial malleoli marker method. Correlations between methods were assessed using Pearson's coefficient and Bland-Altman plots.
Findings
The medial malleoli marker method correlated more strongly with EOS imaging (r = 0.66) than the conventional model (r = 0.27). It also showed excellent agreement with passive goniometer measurements (r = 0.92). EOS imaging consistently reported higher torsion values compared to other methods.
Interpretation
Adding a medial malleolus marker enhances the accuracy and reliability of tibial rotation measurements compared to the conventional gait model. While discrepancies exist with EOS imaging, the medial malleoli marker method shows stronger alignment with both passive and imaging-based assessments.
期刊介绍:
Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field.
The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management.
A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly.
Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians.
The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time.
Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.