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Torsional Deformities


Torsional lesions have a strong implication on the gait and leg pains. For instance a high femoral antetorsion creates pain of knees at jogging. Torsion of quadriceps are often very high in dislocation of the knee cap, by pulling the patella on the lateral side.

Specific treatments can be performed using intramedullary nails.

Torsional values are:

  • Acetabulum torsion (the hip cup in the pelvis is watching forward by): 8-12°
  • Femoral torsion (when the knee is forward, the hip is tilted anteriorly by): 12° (range 6-20°)
  • Tibial external torsion is 20-40°
  • The quadriceps is externally rotated by 10-30° with respect to the knee.

Torsion changes during growth.


Correction can be performed using stab incisions.

The femurs can be involved variably, the tibias too, but sometimes both femur and tibia are concerned, like in quadruple torsion syndroms. Patients have difficulties to jog, and correction can involve both femora and tibiae.

Picture set after surgery

Picture: The 16 year-old patient had a genu varum, knee recurvatum and quadruple torsion syndrome. Correction of all deformities was handled with stab incisions and intramedullary nails through only 2 surgeries. The patient could then walked fast (3 weeks after each surgery) with feet aligned, and could run later with no pain.


Quadriceps is placed too laterally with respect to the knee cap and patellar groove on the femur (hyper-quadriceps torsion) can pull the patella (knee cap) laterally, resulting in hyper-pressure of the patella (pain even in adulthood) or dislocation of the knee cap.Axis correction X-ray

Picture: Dislocation of the patella due to a too lateral position of the quadriceps and retroversion of femoral neck. A double osteotomy of the femur was performed to realign the quadriceps over the knee femoral groove.Axis correction X-ray

Picture: Patient having pain at jogging, climbing stairs, etc. A torsional analysis showed abnormal quadriceps torsion with retroversion of femoral neck, requiring surgery, differently for both femurs.