Infratuberositary derotational tibial osteotomy for anterior knee pain in patients with pathological external tibial torsion: A novel technique

Pathological external tibial torsion is recognized as a cause of anterior knee pain. Derotational tibial osteotomy is a promising surgical intervention for anterior knee pain in patients with excessive external tibial torsion. It is indicated in disabling anterior knee pain recalcitrant to an appropriate conservative treatment with external tibial torsion >35°. However, there is currently no strong evidence supporting specific torsion angles as a standalone indication for surgery. It is contraindicated in patients with pathological external tibial torsion without clinical symptoms or for cosmetic reasons. This technical note describes our surgical technique of derotational osteotomy to correct pathological external tibial torsion in patients with a normally positioned tibial tuberosity. When there is an excess of external tibial torsion and the foot is placed in a forward direction during gait, the knee joint is pointed inward, and this increases the Q angle and thereby the lateral quadriceps vector. When we internally rotate the distal tibial fragment of the osteotomy to the pre-planned correction, the knee faces forward when the foot points forward during gait, thereby correcting the excessive lateral quadriceps vector by reducing the Q angle. Good clinical outcomes and few complications have been reported with this surgical technique.