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Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Increased femoral anteversion (FAV) can have many clinical manifestations, including anterior knee pain (AKP). To our knowledge, no studies have measured the location of FAV in a cohort of female AKP patients. The objective of this research is to determine whether the increased FAV in AKP females originates above the lesser trochanter, below the lesser trochanter or at both levels.

Materials and methods

Thrity-seven consecutive AKP female patients (n = 66 femurs) were recruited prospectively. There were 17 patients (n = 26 femurs; mean age of 28 years) in whom the suspicion for the increased FAV of the femur was based on the clinical examination (pathological group—PG). The control group (CG) consisted of 20 patients (n = 40 femurs; mean age of 29 years) in whom there was no increased FAV from the clinical standpoint. All of them underwent a torsional computed tomography of the lower limbs. FAV was measured according to Murphy´s method. A segmental analysis of FAV was performed using the lesser trochanter as a landmark.

Results

Significant differences in the total FAV (18.7 ± 5.52 vs. 42.46 ± 6.33; p < 0.001), the neck version (54.88 ± 9.64 vs. 64.27 ± 11.25; p = 0.0006) and the diaphysis version (− 36.17 ± 8.93 vs. − 21.81 ± 11.73; p < 0.001) were observed between the CG and the PG. The difference in the diaphyseal angle between CG and PG accounts for 60% of the total difference between healthy and pathological groups, while the difference between both groups in the angle of the neck accounts for 40%.

Conclusion

In chronic AKP female patients with increased FAV, the two segments of the femur contribute to the total FAV, with a different pattern among patients and controls, being the compensation mechanism of the diaphysis much lower in the pathological femurs than in the controls.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain

    Vicente Sanchis-Alfonso, Alejandro Roselló-Añón & Caterina Chiappe

  2. Department of Radiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain

    Cristina Ramírez-Fuentes & Luis Martí-Bonmatí

  3. GIBI230 Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain

    María Beser-Robles

  4. Department of Orthopedic Surgery, Clinica Universidad de Navarra, Pamplona, Spain

    Julio Doménech-Fernández

Authors
  1. Vicente Sanchis-Alfonso
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  2. Cristina Ramírez-Fuentes
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  3. María Beser-Robles
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  4. Alejandro Roselló-Añón
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  5. Caterina Chiappe
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  6. Luis Martí-Bonmatí
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  7. Julio Doménech-Fernández
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Correspondence to Vicente Sanchis-Alfonso.

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Ethical approval

The study was approved by the clinical research ethics committee at our institution (IRB 2020-277-1) and conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Sanchis-Alfonso, V., Ramírez-Fuentes, C., Beser-Robles, M. et al. Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur. Arch Orthop Trauma Surg 144, 51–57 (2024). https://doi.org/10.1007/s00402-023-05036-0

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  • DOI: https://doi.org/10.1007/s00402-023-05036-0

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