Torsional Deformity Masquerading as Knee Instability
Persistent knee pain and gait disturbance exposed an overlooked lower extremity diagnosis.
By
Kathryn Wighton
February 13, 2026
Clinical Scorecard: Torsional Deformity Masquerading as Knee Instability
At a Glance
Category Detail
Condition Lower Extremity Torsional Abnormalities (LETA) Key Mechanisms Axial malalignment including femoral anteversion and external tibial torsion Target Population Adolescents with chronic anterior knee pain and atypical gait patterns Care Setting Orthopedic evaluation and surgical intervention
Key Highlights
Patient presented with chronic anterior knee pain and gait dysfunction despite normal knee imaging. Significant axial malalignment identified via computed tomography and EOS imaging. Three-dimensional gait analysis revealed dynamic multiplanar abnormalities. Surgical correction resulted in resolution of pain and normalization of gait mechanics. LETA is an underrecognized cause of anterior knee pain in adolescents. Guideline-Based Recommendations
Diagnosis
Consider lower extremity torsional abnormalities in adolescents with unexplained knee pain. Utilize three-dimensional gait analysis for comprehensive assessment. Management
Initial conservative management may include physiotherapy and bracing. Surgical intervention may be necessary for persistent symptoms. Monitoring & Follow-up
Follow-up assessments should include objective gait analysis and patient-reported outcomes. Risks
Failure to recognize LETA may lead to prolonged pain and functional limitations. Patient & Prescribing Data
Adolescents with normal intra-articular imaging but significant knee pain.
Surgical correction can lead to significant improvement in symptoms and function.
Clinical Best Practices
Maintain a high index of suspicion for rotational malalignment in knee pain cases. Incorporate advanced imaging techniques for accurate diagnosis of torsional deformities. References
