Document Type

Article

Publication Date

5-2026

Publisher

Elsevier

Source Publication

Nursing Outlook

Source ISSN

0029-6554

Abstract

Introduction

Lower extremity torsional abnormalities (LETA) include excessive femoral and/or tibial torsion and can be associated with pain, functional limitations and patellofemoral instability. This study examined whether clinical differences exist between surgically and nonoperatively managed patients.

Methods

Patients aged 10-21 years with LETA referred for nonoperative or surgical treatment underwent imaging, physical assessment (range of motion (ROM), handheld dynamometry, patellofemoral tests), gait analysis and patient-reported outcomes (PROs: PODCI, FAQ, PEDI-IKDC, APPT, Cosmetic ratings, PROMIS, HAGOS). A control group of typically developing participants underwent the same assessments except imaging. Groups were compared using ANOVA/Kruskal-Wallis test, and statistical parametric mapping.

Results

Thirty-four patients (surgery n = 21, 16.3 ± 2.3 years; nonoperative n = 13, 14.7 ± 2.0 years) and 21 controls (15.8 ± 2.7 years) were included. Femoral version, tibial torsion, ROM, and muscle strength did not differ between treatment groups. Signs of patellofemoral instability were more frequent in the surgical group (MPFL laxity: 14/21 vs 1/13, p <  0.001; apprehension: 13/19 vs 1/13, p <  0.001; J-sign: 11/21 vs 1/13, p = 0.01). Pain was similar between treatment groups (PODCI Pain ≈58%; APPT ≈3–4/10; PROMIS Pain Interference 53–54). PROs showed a tendency toward worse knee function in the surgical group (PEDI-IKDC: 55.0 ± 18.0 vs 67.5 ± 14.6), while the nonoperative group scored lower on HAGOS Activity of Daily Living (96.0 ± 10.2 vs 81.9 ± 22.4, p = 0.01) and Function in Sport and Recreation (87.3 ± 20.2 vs 73.8 ± 24.3, p = 0.03). Gait differences were limited. The nonoperative group demonstrated greater knee flexion at terminal stance than controls.

Conclusion

Both surgical and nonoperative patients differed from age-matched controls across multiple measures, supporting the need for treatment in either pathway. However, differences between the treatment groups were modest aside from greater patellofemoral instability in the surgical group. These findings highlight the need for clear, consensus-based guidelines to define treatment pathways.

Comments

Accepted version. Nursing Outlook, Vol. 75 (2026): 255. DOI. © 2026 Elsevier. Used with permission.

Available for download on Tuesday, June 01, 2027

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