The Bimalleolar Method Shows the Most Reliable Results for Measuring Tibial Torsion in Rotational MRI

Background: The reproducible measurement of tibial torsion (TT) is essential for the diagnosis and evaluation of rotational deformities of the tibia, particularly in the planning of tibial derotational osteotomy. While various CT-based methods for determining the distal tibial axis have been described for adult patients, rotational Magnetic Resonance Imaging (MRI) represents a radiation-free alternative, especially for assessing lower limb rotation in pediatric patients. The aim of this study was to analyze the reliability of TT measurements as well as to investigate potential differences in the application of rotational MRI within a pediatric orthopedic cohort. Methods: In this retrospective study, 78 lower legs from 39 patients aged 4 to 18 years who underwent rotational MRI were included. Measurements for TT were performed using the Jend method, the Waidelich method, and the bimalleolar method. Reliability assessments were conducted by three different examiners, and the results were determined using the intraclass correlation coefficient (ICC). Results: All three methods demonstrated excellent interobserver reliability. The highest intraobserver reliability was achieved using the bimalleolar method (ICC: 0.947). When comparing the assessment of TT, the Jend method showed the highest mean values (34°, standard deviation (SD) 11.0°) followed by the Waidelich method (29°, SD 10.2°) and the bimalleolar method (26°, SD 9.9°). Measurement methods showed a mean difference of up to 8° (p < 0.001). Conclusions: Rotational MRI is a feasible radiation-free option to assess tibial torsion in pediatric and adolescent patients. All tested methods show excellent inter- and intraobserver reliability. Notably, significant differences were found between the measurement methods, with the bimalleolar method showing lower mean values. This has to be taken into account for preoperative planning of rotational and derotational tibial and supramalleolar osteotomies.