title: Can turned inward patella predict an excess of femoral anteversion during gait in spastic diplegic children?
abstract: BACKGROUND
  Determining patellar orientation in the transverse plane during observational gait analysis is a fundamental aspect of physical examinations. Many physicians consider that an abnormal position of the patella in the transverse planes is only explained by a rotational abnormality of the proximal femur.
  
  
  METHODS
  A total of 188 spastic diplegic children with cerebral palsy were reviewed (376 lower limbs). The physical examination included observation of patellar orientation at midstride and measuring femoral anteversion (FA). All patients also underwent 3-dimensional (3D) computerized gait analysis of pelvic and hip rotation kinematics.
  
  
  RESULTS
  Observational gait analysis and videotapes found 103 children (206 lower limbs) with inturned patella at midstance. Kinematic data from 3D gait analysis showed that the visual impression of turned inward patella was erroneous in 48 limbs. Of the remaining 158 lower limbs, 117 (74%) exhibited excessive FA and 41 (26%) did not. Of the 117 with excessive FA, kinematics showed only 66 (56%) with excessive internal hip rotation (with or without excessive internal pelvic rotation). Of the 41 lower limbs without excessive FA, 25 were explained by excessive internal pelvic rotation and 16 were explained by excessive internal hip rotation (isolated spasticity and/or contracture of internal rotator muscles). Turned inward patella was caused by isolated excessive internal pelvic rotation in 48%, excessive internal hip rotation in 35% (including 44 cases with excessive FA and 12 cases with isolated spasticity and/or contracture of internal hip rotators), and excessive internal hip rotation combined with excessive internal pelvic rotation in 17%.
  
  
  CONCLUSIONS
  Excessive FA was not the only cause of turned inward patella gait and could not explain this gait anomaly by itself. Excessive internal pelvic rotation was the most frequent cause of turned inward patella gait.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Robert Debré Hospital, APHP, Paris 7 University, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Simon
authors.forename: Ana
authors.initials: A
authors.lastname: Presedo
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Cindy
authors.initials: C
authors.lastname: Mallet
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.forename: Georges-François
authors.initials: GF
authors.lastname: Penneçot
mesh_terms: D000293:Adolescent; D000328:Adult; D053587:Arthrometry, Articular; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000002:abnormalities*; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000503:physiopathology*; D006615:Hip; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000503:physiopathology; D010329:Patella / Q000002:abnormalities*; D010388:Pelvis / Q000503:physiopathology; D010808:Physical Examination; D012399:Rotation; D014102:Torsion Abnormality / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult