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Increased femoral antetorsion correlates with higher degrees of lateral retropatellar cartilage degeneration, further accentuated in genu valgum

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The role of increased femoral antetorsion (femAT) as a contributor to patellofemoral (PF) osteoarthritis (OA) is unknown. The purpose of this study was to investigate whether increased femAT was associated with advanced cartilage degeneration in the lateral PF joint.

Methods

Patients who underwent complete radiographic workup for surgical intervention due to OA in any knee joint compartment were included. Cartilage morphology according to the International Cartilage Repair Society (ICRS) cartilage lesion classification system in the PF joint, femoral and tibial torsion, frontal leg axis, and tibial tuberosity-trochlear groove (TT-TG) distance were assessed. Increased femAT was defined as  > 20° according to previous reports.

Results

A total of 144 patients were included. Ninety-seven patients had a femAT of  < 20° and 45 of  > 20°. A significant odds ratio (OR) was found for lateral retropatellar (OR 3.5; p = 0.02) ICRS grade 3 and 4 cartilage degeneration and increased femAT  ≥ 20°. In the medial PF compartment, increased femAT had an inverse effect (OR 0.16; p = 0.01). No significant ORs were found for TT-TG distance, tibial torsion, or leg axis. The lateral retropatellar ICRS grade showed a linear correlation to increased femAT values. In valgus knees, isolated lateral PF OA had an even more pronounced correlation to increased femAT (p = 0.004).

Conclusion

Increased femAT showed higher grades of lateral retropatellar cartilage degeneration, which was even more pronounced in valgus knees.

Level of Evidence

Cohort study: Level III.

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Authors’ contributions

FA and IFB researched literature and conceived the study. FA, IFB and FSF were involved in protocol development and gaining ethical approval. FA and HA were involved in patient recruitment. Radiological assessment was performed by FA, HA and IFB. IFB, FA and OA were involved in data analysis. FA wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Balgrist University Hospital, Orthopaedic Department, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland

    A. Flury, A. Hoch, O. Andronic, F. B. Imhoff & S. F. Fucentese

  2. Balgrist University Hospital, Department of Radiology, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    B. Fritz

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  1. A. Flury
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Correspondence to F. B. Imhoff.

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Ethical approval for this study was obtained from Zurich Cantonal Ethics Comission: KEK 2020-00809.

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Flury, A., Hoch, A., Andronic, O. et al. Increased femoral antetorsion correlates with higher degrees of lateral retropatellar cartilage degeneration, further accentuated in genu valgum. Knee Surg Sports Traumatol Arthrosc 29, 1760–1768 (2021). https://doi.org/10.1007/s00167-020-06223-x

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