Project 458823

Knee pain is common, affecting 29% of adolescents. One of the underlying causes is a torsional deformity of the tibia and/or femurs. This has been termed "lower extremities torsional abnormalities", or LETA. At the Shriners Hospitals for Children-Canada, we have developed an expertise in this field. LETA is characterized by a combination of internal torsion of the femur and external torsion of the tibia. The combination of these torsional deformities is often associated with knee and hip pain and often causes adolescents to stop all physical activities. Due to a lack of knowledge on LETA, adolescents consult many health professionals without finding the cause of their pain and may undergo non-surgical or surgical treatments with disappointing results. When correctly diagnosed, the common treatment for this condition is a surgery. The femur and tibia are osteotomized (or surgical cut) to derotate them to a more anatomic position. This realigns the limb, specifically at the knee joint and leads to pain relief. Clinicians need to understand the impact of LETA on mobility, function, pain and gait patterns and surgeons must appreciate the postoperative outcomes to optimally diagnose and treat this condition. This study aims to quantify the impact of the deformities on pain, function and mobility, and to determine if the surgery leads to improvements. Twenty-eight individuals with LETA that will undergo a surgery will be recruited at three Shriners Hospitals for Children (Canada (n=16), Chicago (n=6) and Portland (n=6)). They will perform multiple assessments (clinical, bone imaging, gait analysis and questionnaires) before and one year after their surgery. Understanding the effect of LETA on function, mobility and pain as well as the impact of the surgery is the key to improve the therapeutic and surgical management decisions. This project is the first of a series that should lead to the development of best practices for the management of torsional abnormalities.