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

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.