# Anterior Knee Pain and Excessive External Tibial Torsion in Female Patients: Rationale and Outcomes of Rotational Tibial Osteotomy

## TL;DR

This paper discusses how excessive tibial torsion causes knee pain in women and explores the effectiveness of tibial osteotomy as a treatment.

## Contribution

The study provides rationale and outcomes for rotational tibial osteotomy in treating anterior knee pain due to excessive external tibial torsion in female patients.

## Key findings

- Internal rotational tibial osteotomy is a reliable treatment for symptomatic excessive external tibial torsion.
- Outcomes of the procedure are favorable with minimal complications in appropriately selected cases.

## Abstract

Excessive external tibial torsion (ETT) is a recognized cause of anterior knee pain (AKP). In patients with excessive ETT, placing the foot forward during gait causes the knee joint to point inward, increasing the Q-angle and the lateral quadriceps vector. In appropriately selected cases, internal rotational tibial osteotomy is a reliable treatment option for symptomatic excessive ETT, yielding favorable outcomes with minimal complications. Nevertheless, no universally accepted torsion threshold exists to guide surgical decision-making, and evidence remains limited regarding the optimal anatomic level for performing the osteotomy.