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Increased femoral anteversion related to infratrochanteric femoral torsion is associated with ACL rupture

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To determine the association between femoral torsion and anterior cruciate ligament (ACL) rupture and determine the level of torsion using magnetic resonance imaging (MRI).


The medical records of patients who were diagnosed with ACL injury were reviewed retrospectively. This descriptive epidemiological study included 2344 patients. MRI scans were examined and patients with femur and knee MRI scans obtained at the same time were identified (ACL-deficient group). Twenty-eight of them had femur and knee MRI scans because of an incidental benign lesion in the distal femur. Patients who were diagnosed with enchondroma were followed up by MRI evaluation of the femur and were randomly selected as controls. Supratrochanteric torsion (STT), infratrochanteric torsion (ITT), and femoral anteversion (FA) were measured by orthopedic surgeons with at least 5 years of experience.


Age, sex, and side properties were similar in both groups. The mean FA values were 19.4 ± 3.0 degrees and 11.9 ± 2.0 degrees in the ACL-deficient and control groups, respectively (p < 0.001). STT was similar in the ACL-deficient and control groups [mean: 38.2 ± 4.3 and 37.7 ± 3.3, respectively, (n.s.)]. ITT was increased in the ACL-deficient group compared with the control group (mean − 18.8 ± 4.3 and − 25.8 ± 3.8, respectively; p < 0.001).


According to our results, increased FA was associated with ACL rupture. Further, the torsional abnormality was developed from the ITT. We concluded that each ACL-deficient patient should be assessed by a clinician for torsional abnormality using physical examination.

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Correspondence to Yakup Alpay.

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Conflict of interest

Yakup Alpay, Atakan Ezici, Bilal Kurk, Osman Nuri Ozyalvac, Evren Akpinar, Avni Ilhan Bayhan declare no conflict of interest.

Ethical approval

The study was approved by the Health Sciences University Baltalimani Bone and Joint Diseases Training and Research Hospital institutional review board (Approval ID number: 43-304).



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The need for informed consent was waived because of the study’s retrospective descriptive epidemiological design.

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Alpay, Y., Ezici, A., Kurk, M. et al. Increased femoral anteversion related to infratrochanteric femoral torsion is associated with ACL rupture. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-05874-0

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  • Anterior cruciate ligament injury
  • Anterior cruciate ligament
  • Femoral anteversion
  • Supratrochanteric torsion
  • Infratrochanteric torsion
  • Risk factor