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Ziegenhorn J, Kirschberg J, Heinecke M, von Eisenhart-Rothe R, Matziolis G. Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4. Knee Surg Sports Traumatol Arthrosc 2024; 32:1199-1206. [PMID: 38511851 DOI: 10.1002/ksa.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type. METHODS Five hundred patients (1000 legs) were included, who received a whole leg standing three-dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK. RESULTS The mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion. CONCLUSION There is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonas Ziegenhorn
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- German Knee Society (DKG), Munich, Germany
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
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Fan C, Niu Y, Hao K, Kong L, Huo Z, Lin W, Wang F. Clinical outcomes of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in patients with patellar dislocation and increased femoral anteversion unaffected by the pattern of distribution of femoral torsion. Knee Surg Sports Traumatol Arthrosc 2024; 32:19-28. [PMID: 38226671 DOI: 10.1002/ksa.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of this study was to evaluate the clinical effect of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction for patellar dislocation and the effect of the distribution of femoral torsion at different segments on postoperative function. METHODS Forty-two patients with patellar dislocation who underwent derotational femoral osteotomy from 2017 to 2021 were retrospectively analysed. All patients received computed tomography scans from the hip to the knee to evaluate correction of the femoral anteversion (FA) angle, patellar tilt angle (PTA) and congruence angle (CA) after derotational femoral osteotomy. Subjective scores, such as the Kujala, Lysholm, International Knee Documentation Committee (IKDC), Tegner and visual analog scale (VAS) scores, were used to evaluate knee function before and after the operation. Patients with supracondylar torsion > distal torsion were categorized into the supracondylar torsion group and patients with distal torsion > supracondylar torsion were categorized into the distal torsion group. Subgroup analyses were performed. RESULTS No presentation of redislocation occurred in these patients at the minimum 2-year follow-up visit. The mean preoperative FA angle in the supracondylar torsion group was 30.2° ± 4.2°, and the mean postoperative FA angle was 14.5° ± 2.5° (p < 0.001). The mean preoperative FA angle was 26.7° ± 1.4° and the mean postoperative FA angle was 14.1° ± 1.4° in the distal torsion group. In addition, postoperative PTA and CA were significantly corrected in both groups (p < 0.001). The postoperative Kujala, Lysholm, IKDC, Tegner and VAS scores were significantly improved in both groups (p < 0.001). Subgroup analyses showed a higher preoperative FA in the supracondylar torsion group and a higher occurrence of high-grade trochlear dysplasia in the distal torsion group. However, there was no significant difference in their postoperative clinical outcomes. CONCLUSION Through a minimum of 2-year follow-up visits of patients with patellar dislocation and increased FA, it was found that derotational femoral osteotomy could significantly reduce FA and improve subjective knee function. The pattern of torsion distribution did not significantly affect the clinical outcomes of derotational femoral osteotomy. These findings readvised orthopaedic surgeons that derotational femoral osteotomy remains the preferred procedure for correcting rotational malalignment, but that they should be more cautious about its indications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chongyi Fan
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Yingzhen Niu
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Kuo Hao
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Lingce Kong
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Zhenhui Huo
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Wei Lin
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Joint Surgery, Hebei Medical University Affiliated Third Hospital, Shijiazhuang, Hebei, China
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Chen X, Ji G, Xu C, Wang F. Association Between Femoral Anteversion and Distal Femoral Morphology in Patients With Patellar Dislocation and Trochlear Dysplasia. Orthop J Sports Med 2023; 11:23259671231181937. [PMID: 37576457 PMCID: PMC10413895 DOI: 10.1177/23259671231181937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 08/15/2023] Open
Abstract
Background Increased femoral anteversion (FA) is reportedly associated with patellar dislocation (PD) and trochlear dysplasia (TD), and the increase in FA may occur at different segments of the femur. In addition, TD is associated with dysplasia of the posterior femoral condyle. Among patients with PD, whether FA is greater with or without TD remains unclear. Purpose To explore differences in FA and torsion distribution at different femoral sections among patients with PD and TD, patients with PD and no TD, and sex- and age-matched controls and to investigate the association between FA and distal femoral morphology. Study Design Cross-sectional study; Level of evidence, 3. Methods This study involved 132 knees: 44 knees with PD and TD, 44 knees with PD but no TD, and 44 control knees. FA, proximal torsion (PT), middle torsion (MT), distal torsion (DT), and distal femoral morphology were measured. Differences were investigated by 1-way analysis of variance. Pearson correlation analysis was conducted to explore the association between FA and each parameter. Results FA was significantly larger in the PD with TD group (25.4° ± 4.7°) than in the other groups (controls: 18.9° ± 5.6°; PD without TD: 19.9° ± 4.8°) (P < .01). DT was significantly larger in the PD with TD group (15.8° ± 2.9°) than in the other groups (controls: 9.0° ± 4.3°; PD without TD: 8.8° ± 3.9°) (P < .01). In all 3 groups, FA was strongly positively correlated with DT (control, PD without TD, and PD with TD, respectively: r = 0.76, 0.80, and 0.88; P < .01), strongly positively correlated with the posteromedial condylar length (r = 0.48, 0.48, and 0.70; P < .01) and negatively correlated with the posterolateral condylar length (r = -0.30, -0.35, and -0.78, respectively; P < .05). Conclusion The increased FA in knees with TD was due mainly to DT rather than PT or MT, which may provide a reference for choosing the optimal position for femoral derotation osteotomy.
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Affiliation(s)
- Xiaobo Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenyue Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Alter TD, Fenn TW, Kaplan DJ, Rice MW, Nho SJ. Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Am J Sports Med 2023; 51:2540-2550. [PMID: 37382350 DOI: 10.1177/03635465231182151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). PURPOSE To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. RESULTS A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, -6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers' compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively (P < .01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs (P≥ .515) and PRO values at 5-year follow-up (P≥ .098). There were no significant differences in the achievement of the minimal clinically important difference (P≥ .422) or Patient Acceptable Symptom State (P≥ .161) for any of the PROs among the torsion groups. CONCLUSION The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study's cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up.
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Affiliation(s)
- Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Qiao Y, Ye Z, Zhang X, Xu X, Xu C, Li Y, Zhao S, Zhao J. Effect of Lower Extremity Torsion on Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer for Recurrent Patellofemoral Instability. Am J Sports Med 2023; 51:2374-2382. [PMID: 37306061 DOI: 10.1177/03635465231177059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Increased femoral torsion (FT) or tibial torsion (TT) has been suggested to be a potential risk factor for recurrent patellofemoral instability. However, the influence of increased FT or TT on the postoperative clinical outcomes of recurrent patellofemoral instability has rarely been investigated. PURPOSE To assess the effect of increased FT or TT on postoperative results in patients with recurrent patellofemoral instability after combined medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle transfer, along with the influence of other risk factors. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Out of 91 patients, the study's analyses included 86 patients with recurrent patellofemoral instability who were treated with MPFLR and tibial tubercle transfer and enrolled between April 2020 and January 2021. FT and TT were assessed using preoperative computed tomography images. According to the torsion value of FT or TT, patients were categorized into 3 groups for each of FT and TT: group A (<20°), group B (20°-30°), and group C (>30°). Patellar height, femoral trochlear dysplasia, and the tibial tuberosity-trochlear groove (TT-TG) distance were also assessed. Patient-reported outcome scores (Tegner, Kujala, International Knee Documentation Committee [IKDC], Lysholm, and Knee injury and Osteoarthritis Outcome Score [KOOS]) were evaluated pre- and postoperatively. Clinical failure of MPFLR was recorded. Subgroup analysis was conducted to evaluate the effect of increased FT or TT on the postoperative outcomes. RESULTS A total of 86 patients were enrolled with a median follow-up time of 25 months. At the final follow-up, all functional scores improved significantly. Patella alta, high-grade trochlear dysplasia, and increased TT-TG distance did not have any significant effect on the postoperative functional scores. Regarding FT, subgroup analysis indicated that all functional scores of group C were lower than those of groups A and B except the KOOS knee-related Quality of Life score. For TT, group C had lower scores than group A for all functional outcomes except Tegner and KOOS Quality of Life and lower scores than group B for Kujala, IKDC, KOOS (Symptoms and Sport and Recreation subscales), Tegner, and Lysholm scores. The comparison between group A and group B, whether for FT or TT, revealed no significant differences. CONCLUSION For patients with recurrent patellofemoral instability, increased lower extremity torsion (FT or TT >30°) was associated with inferior postoperative clinical outcomes after combined MPFLR and tibial tubercle transfer.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Xiaoyu Xu
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Boschung A, Antioco T, Steppacher SD, Tannast M, Novais EN, Kim YJ, Lerch TD. Posterior Hip Impingement at Maximal Hip Extension in Female Patients With Increased Femoral Version or Increased McKibbin Index and Its Effect on Sports Performance. Orthop J Sports Med 2023; 11:23259671231184802. [PMID: 37529532 PMCID: PMC10387700 DOI: 10.1177/23259671231184802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 08/03/2023] Open
Abstract
Background The location of posterior hip impingement at maximal extension in patients with posterior femoroacetabular impingement (FAI) is unclear. Purpose To investigate the frequency and area of impingement at maximal hip extension and at 10° and 20° of extension in female patients with increased femoral version (FV) and posterior hip pain. Study Design Cross-sectional study; Level of evidence, 3. Methods Osseous patient-specific 3-dimensional (3D) models were generated of 50 hips (37 female patients, 3D computed tomography) with a positive posterior impingement test and increased FV (defined as >35°). The McKibbin index (combined version) was calculated as the sum of FV and acetabular version (AV). Subgroups of patients with an increased McKibbin index >70° (24 hips) and FV >50° (20 hips) were analyzed. A control group of female participants (10 hips) had normal FV, normal AV, and no valgus deformity (neck-shaft angle, <139°). Validated 3D collision detection software was used for simulation of osseous impingement-free hip extension (no rotation). Results The mean impingement-free maximal hip extension was significantly lower in patients with FV >35° compared with the control group (15° ± 15° vs 55° ± 19°; P < .001). At maximal hip extension, 78% of patients with FV >35° had osseous posterior extra-articular ischiofemoral hip impingement. At 20° of extension, the frequency of posterior extra-articular ischiofemoral impingement was significantly higher for patients with a McKibbin index >70° (83%) and for patients with FV >35° (76%) than for controls (0%) (P < .001 for both). There was a significant correlation between maximal extension (no rotation) and FV (r = 0.46; P < .001) as well as between impingement area at 20° of extension (external rotation [ER], 0°) and McKibbin index (0.61; P < .001). Impingement area at 20° of extension (ER, 0°) was significantly larger for patients with McKibbin index >70° versus <70° (251 vs 44 mm2; P = .001). Conclusion The limited hip extension found in our study could theoretically affect the performance of sports activities such as running, ballet dancing, or lunges. Therefore, although not examined directly in this study, these activities are not advisable for these patients. Preoperative evaluation of FV and the McKibbin index is important in female patients with posterior hip pain before hip preservation surgery (eg, hip arthroscopy).
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Affiliation(s)
- Adam Boschung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Eduardo N. Novais
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-jo Kim
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Huettner F, Lutter C, Zuehlke C, Kfuri M, Tischer T, Harrer J. Determination of Standard Values for Knee Version in a Healthy Population. Am J Sports Med 2023; 51:949-956. [PMID: 36803062 DOI: 10.1177/03635465231152475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Different measures are used to describe relevant anatomic variations that can result in patellofemoral instability and disorders. Knee version, the relative rotational alignment between the femur and tibia in the axial plane at the level of the knee, may have a decisive effect on the kinematics of the patellofemoral joint. However, data regarding the values of knee version are currently lacking. PURPOSE This study aimed to determine standard values for knee version in a healthy population. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 100 healthy volunteers (50 male and 50 female) without patellofemoral disorders or lower extremity malalignment were included in this study and underwent knee magnetic resonance imaging. The torsion values of the femur and tibia were independently measured using the Waidelich and Strecker method. Knee version, defined as static rotation of the tibia with respect to the femur in full extension, was determined by measuring the angle between the tangent lines to the dorsal femoral condyle (DFC) and the dorsal tibial head (DTH; defined by the posterior point of the proximal tibial plateau). Supplementary measurements were obtained as follows: (1) femoral epicondylar line (FEL), (2) tibial ellipse center line (TECL), (3) tibial tuberosity-trochlear groove (TT-TG) distance, and (4) tibial tuberosity-posterior cruciate ligament (TT-PCL) distance. RESULTS In 200 analyzed legs of 100 volunteers (mean age, 26.5 ± 5.8 years [range, 18 to 40 years]), we identified a mean internal femoral torsion of -23.8°± 9.7° (range, -46.2° to 1.6°), external tibial torsion of 33.2°± 7.4° (range, 16.4° to 50.3°), and external knee version (DFC to DTH) of 1.3°± 3.9° (range, -8.7° to 11.7°). Other measurements were as follows: FEL to TECL, -0.9°± 4.9° (range, -16.8° to 12.1°); FEL to DTH, -3.6°± 4.0° (range, -12.6° to 6.8°); and DFC to TECL, 4.0°± 4.9° (range, -12.7° to 14.7°). The mean TT-TG distance was 13.4 ± 3.7 mm (range, 5.3-23.5 mm), and the mean TT-PCL distance was 11.5 ± 3.5 mm (range, 6.0-20.9 mm). Female participants had significantly greater external knee version than male participants. CONCLUSION Coronal- and sagittal-plane alignments of the knee have a well-known effect on the biomechanics of this joint. Additional information about the axial plane may result in new decision-making algorithms for managing knee disorders. This study is the first to report standard values of knee version in a healthy population. As a subsequent step building on this work, we advocate for the measurement of knee version in patients with patellofemoral disorders, as this parameter may assist with new treatment guidelines in the future.
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Affiliation(s)
- Felix Huettner
- Department of Orthopaedic Surgery, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
- Department of Orthopaedic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Constantin Zuehlke
- Department of Radiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Thomas Tischer
- Department of Orthopaedic Surgery, Rostock University Medical Center, Rostock, Germany
- Department of Orthopaedic Surgery, Malteser Waldkrankenhaus St Marien, Erlangen, Germany
| | - Joerg Harrer
- Department of Orthopaedic Surgery, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
- Committee Osteotomy, German Knee Society (DKG), Germany
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Xu Z, Song Y, Deng R, Zhang Z, Wang H, Yu JK. Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment. Orthop J Sports Med 2022; 10:23259671221125218. [PMID: 36329949 PMCID: PMC9623427 DOI: 10.1177/23259671221125218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Femoral torsion can be evaluated from different femoral segments. The
pathological thresholds for femoral torsion of different segments and the
influence of segmental femoral torsion on patellofemoral alignment remain
unknown. Purpose To compare femoral torsion between patients with recurrent patellar
dislocation and healthy individuals, to determine the statistical
physiological range and pathological thresholds of femoral torsion in
different segments, and to investigate the influence of femoral torsion on
patellofemoral malalignment. Study Design Cross-sectional study; Level of evidence, 3. Methods We retrospectively reviewed the records of patients with patellar dislocation
who received surgical treatment in our department between 2019 and 2020.
Healthy participants were recruited as the control group. The control
patients were asymptomatic and had no history of lower extremity disorders.
The differences in femoral torsion between the study and control groups were
compared. The diagnostic capacity of femoral torsion in different segments
and their correlation with patellar tilt were investigated. The mean value
and 95% CI of femoral torsion in different segments were established using
data from healthy volunteers. Results A total of 60 patients with patellar dislocation and 100 healthy volunteers
were included in this study. The total, mid, and distal femoral torsion
values differed significantly between the study and control groups
(P < .01). Total femoral torsion had the highest
diagnostic value (area under the receiver operating curve = 0.733). Total
torsion (r = 0.432; P < .001), mid
torsion (r = 0.242; P = .002), and distal
torsion (r = 0.324; P < .001) showed
significant correlations with patellar tilt. The pathological thresholds of
excessive femoral torsion of the total, proximal, mid, and distal femoral
segments were 24.73°, 46.68°, –6.55°, and 14.92°, respectively. Conclusion Patients with patellar dislocation had greater femoral torsion than healthy
individuals in multiple femoral segments. Excessive mid, distal, and total
torsion was associated with more significant patellar tilt.
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Affiliation(s)
- Zijie Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Yifan Song
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Ronghui Deng
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Zining Zhang
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Haijun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
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9
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Lerch TD, Antioco T, Boschung A, Meier MK, Schmaranzer F, Novais EN, Tannast M, Steppacher SD. Hip Impingement Location in Maximal Hip Flexion in Patients With Femoroacetabular Impingement With and Without Femoral Retroversion. Am J Sports Med 2022; 50:2989-2997. [PMID: 36037094 DOI: 10.1177/03635465221110887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Symptomatic patients with femoroacetabular impingement (FAI) have limitations in daily activities and sports and report the exacerbation of hip pain in deep flexion. Yet, the exact impingement location in deep flexion and the effect of femoral version (FV) are unclear. PURPOSE To investigate the acetabular and femoral locations of intra- or extra-articular hip impingement in flexion in patients with FAI with and without femoral retroversion. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS An institutional review board-approved retrospective study involving 84 hips (68 participants) was performed. Of these, symptomatic patients (37 hips) with anterior FAI and femoral retroversion (FV <5°) were compared with symptomatic patients (21 hips) with anterior FAI (normal FV) and with a control group (26 asymptomatic hips without FAI and normal FV). All patients were symptomatic, had anterior hip pain, and had positive anterior impingement test findings. Most of the patients had hip/groin pain in maximal flexion or deep flexion or during sports. All 84 hips underwent pelvic computed tomography (CT) to measure FV as well as validated dynamic impingement simulation with patient-specific CT-based 3-dimensional models using the equidistant method. RESULTS In maximal hip flexion, femoral impingement was located anterior-inferior at 4 o'clock (57%) and 5 o'clock (32%) in patients with femoral retroversion and mostly at 5 o'clock in patients without femoral retroversion (69%) and in asymptomatic controls (76%). Acetabular intra-articular impingement was located anterior-superior (2 o'clock) in all 3 groups. In 125° of flexion, patients with femoral retroversion had a significantly (P < .001) higher prevalence of anterior extra-articular subspine impingement (54%) and anterior intra-articular impingement (89%) compared with the control group (29% and 62%, respectively). CONCLUSION Knowing the exact location of hip impingement in deep flexion has implications for surgical treatment, sports, and physical therapy and confirms previous recommendations: Deep flexion (eg, during squats/lunges) should be avoided in patients with FAI and even more in patients with femoral retroversion. Patients with femoral retroversion may benefit and have less pain when avoiding deep flexion. For these patients, the femoral location of the impingement conflict in flexion was different (anterior-inferior) and distal to the cam deformity compared with the location during the anterior impingement test (anterior-superior). This could be important for preoperative planning and bone resection (cam resection or acetabular rim trimming) during hip arthroscopy or open hip preservation surgery to ensure that the region of impingement is appropriately identified before treatment.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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DeFroda SF, Alter TD, Bodendorfer BM, Newhouse AC, Bessa FS, Williams JC, Nho SJ. Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion. Orthop J Sports Med 2021; 9:23259671211034588. [PMID: 34646896 PMCID: PMC8504247 DOI: 10.1177/23259671211034588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO (P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group (P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group (P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.
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Affiliation(s)
- Steven F DeFroda
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Blake M Bodendorfer
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Felipe S Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Joel C Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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11
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Novais EN, Nunally KD, Ferrer MG, Miller PE, Wylie JD, Dodgen WT. Asymmetrically increased femoral version with high prevalence of moderate and severe femoral anteversion in unilateral Legg-Calvé-Perthes disease. J Child Orthop 2021; 15:503-509. [PMID: 34858538 PMCID: PMC8582613 DOI: 10.1302/1863-2548.15.200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine and stratify femoral version in Legg-Calvé-Perthes disease (LCPD), and to compare the femoral version between the LCPD hip and the contralateral unaffected hip. METHODS We performed a retrospective review of 45 patients with unilateral LCPD who had available CT scan through the hips and knees between January 2000 and June 2017. There were 34 (76%) male cases with a mean age of 14 years (sd 4.69). Two independent readers measured femoral version on the affected and the unaffected contralateral femur. Femoral version was classified as follows: severely decreased version (< 10°); moderately decreased (10° to 14°); normal femoral version range (15° to 20°); moderately increased (21° to 25°); and severely increased version (> 25°). RESULTS LCPD hips had predominantly increased femoral version (38% severely increased anteversion, 24% moderately increased anteversion), while 51% of the contralateral unaffected hips had normal femoral version (p < 0.001). LCPD hips had higher mean femoral version than the contralateral, unaffected side (mean difference = 13o; 95% confidence iterval 10o to 16o; p < 0.001). As the version of the affected hip increased, so did the discrepancy between sides. No effect of sex on the LCPD femoral version was detected (p = 0.34). CONCLUSION This study included a selected group of patients with unilateral LCPD and available CT scans obtained for surgical planning. The femoral version was asymmetric, with a high proportion of excessive anteversion observed at later stages of disease in the affected hips. Future studies will be necessary to determine the pathogenesis of increased femoral version associated with LCPD. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Eduardo N. Novais
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kianna D. Nunally
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Mariana G. Ferrer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Patricia E. Miller
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - James D. Wylie
- The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, Utah, United States
| | - William T. Dodgen
- Department of Orthopaedic Surgery, Cook Children’s Hospital, Fort Worth, Texas, United States
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12
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De Pieri E, Friesenbichler B, List R, Monn S, Casartelli NC, Leunig M, Ferguson SJ. Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults. Front Bioeng Biotechnol 2021; 9:679360. [PMID: 34368092 PMCID: PMC8334869 DOI: 10.3389/fbioe.2021.679360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023] Open
Abstract
Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | | | - Renate List
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Samara Monn
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zürich, Switzerland
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13
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Kunze KN, Alter TD, Newhouse AC, Bessa FS, Williams JC, Nho SJ. Association Between Orientation and Magnitude of Femoral Torsion and Propensity for Clinically Meaningful Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Computed Tomography Analysis. Am J Sports Med 2021; 49:2466-2474. [PMID: 34166125 DOI: 10.1177/03635465211021610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral torsion imaging measurements and classifications are heterogeneous throughout the literature, and the influence of femoral torsion on clinically meaningful outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well studied. PURPOSE To (1) perform a computed tomography (CT)-based analysis to quantify femoral torsion in patients with FAIS and (2) explore the relationship between the orientation and magnitude of femoral torsion and the propensity for clinically meaningful outcome improvement after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients who underwent hip arthroscopy for FAIS between January 2012 and April 2018 were identified. Inclusion criteria were the presence of preoperative CT imaging with transcondylar slices of the knee and minimum 2-year outcome measures. Exclusion criteria were revision hip arthroscopy, Tönnis grade >1, congenital hip condition, hip dysplasia (lateral center-edge angle <20°), and concomitant gluteus medius or minimus repair. Torsion groups were defined as severe retrotorsion (SR; <0°), moderate retrotorsion (MR; 0°-5°), normal torsion (N; 5°-20°), moderate antetorsion (MA; 20°-25°), and severe antetorsion of antetorsion (SA; >25°). Treatment did not differ based on femoral torsion. Patient characteristics and clinical outcomes were analyzed, including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) by torsion stratification was analyzed using the chi-square test. Inter- and intrarater reliabilities for CT measurements were 0.980 (P < .001) and 0.974 (P < .001), respectively. RESULTS The study included 573 patients with a mean ± SD age and body mass index of 32.6 ± 11.8 years and 25.6 ± 10.6, respectively. The mean ± SD femoral torsion for the study population was 12.3°± 9.3°. After stratification, the number of patients within each group and the mean ± SD torsion for each group were as follows: SR (n = 36; -6.5°± 7.1°), MR (n = 80; 2.8°± 1.4°), N (n = 346; 12.3°± 4.1°), MA (n = 64; 22.2°± 1.4°), and SA (n = 47; 30.3°± 3.7°). No significant differences in age, body mass index, sex, tobacco use, workers' compensation status, or participation in physical activity were observed at baseline. No significant differences were seen in pre- and postoperative VAS pain, mHHS, HOS-ADL, HOS-SS, iHOT-12, or postoperative VAS satisfaction among the cohorts. Furthermore, no statistically significant differences were found in the proportion of patients who achieved the MCID or the PASS for any outcome among the groups. CONCLUSION The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS did not influence the propensity for clinically significant outcome improvement.
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Affiliation(s)
- Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA.,Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Felipe S Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Joel C Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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14
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Lerch TD, Zwingelstein S, Schmaranzer F, Boschung A, Hanke MS, Todorski IAS, Steppacher SD, Gerber N, Zeng G, Siebenrock KA, Tannast M. Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT-Based Hip Impingement Simulation of a Modified FABER Test. Orthop J Sports Med 2021; 9:2325967121990629. [PMID: 34104657 PMCID: PMC8167016 DOI: 10.1177/2325967121990629] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Posterior extra-articular hip impingement has been described for valgus hips
with increased femoral version (FV). These patients can present clinically
with lack of external rotation (ER) and extension and with a positive
posterior impingement test. But we do not know the effect of the combination
of deformities, and the impingement location in early flexion is
unknown. Purpose: To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans
of hips with increased FV and control hips for differences in range of
motion, location and prevalence of osseous posterior intra- and
extra-articular hip impingement. Study Design: Case series; Level of evidence, 4. Methods: Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52
hips (38 symptomatic patients) with positive posterior impingement test and
increased FV (>35°). There were 26 hips with an increased McKibbin
instability index >70 (unstable hips). Patients were mainly female (96%),
with an age range of 18 to 45 years. Of them, 21 hips had isolated increased
FV (>35°); 22 hips had increased FV and increased acetabular version (AV;
>25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had
increased FV and increased AV. The control group consisted of 20 hips with
normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle
<139°). Validated 3D CT–based collision detection software for
impingement simulation was used to calculate impingement-free range of
motion and location of hip impingement. Surgical treatment was performed
after the 3D CT–based impingement simulation in 27 hips (52%). Results: Hips with increased FV had significantly (P < .001)
decreased extension and ER at 90° of flexion as compared with the control
group. Posterior impingement was extra-articular (92%) in hips with
increased FV. Valgus hips with increased FV and AV had combined intra- and
extra-articular impingement. Posterior hip impingement occurred between the
ischium and the lesser trochanter at 20° of extension and 20° of ER.
Impingement was located between the ischium and the greater trochanter or
intertrochanteric area at 20° of flexion and 40° of ER, with a modification
of the flexion-abduction-ER (FABER) test. Conclusion: Posterior extra-articular ischiofemoral hip impingement can be caused by the
lesser and greater trochanter or the intertrochanteric region. We recommend
performing the modified FABER test during clinical examination in addition
to the posterior impingement test for female patients with high FV. In
addition, 3D CT can help for surgical planning, such as femoral derotation
osteotomy and/or hip arthroscopy or resection of the lesser trochanter.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sébastien Zwingelstein
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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15
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Biedert RM. Reflections on Rotational Osteotomies around the Patellofemoral Joint. J Clin Med 2021; 10:474. [PMID: 33513870 DOI: 10.3390/jcm10030474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Torsional abnormalities of the femur represent a significant risk factor for patellar instability or patellofemoral complaints. Although their clinical implication has been demonstrated, there is still a debate going on about different aspects. These include, especially, the various methods of measurements with a wide range of physiologic values, the indication or clear recommendation for surgical correction, and the site of the rotational osteotomy. Nevertheless, good subjective and objective functional results were reported after femoral rotational osteotomies. This is mostly not a review of the literature, but a collection of personal thoughts and observations.
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16
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Ferràs-Tarragó J, Sanchis-Alfonso V, Ramírez-Fuentes C, Roselló-Añón A, Baixauli-García F. A 3D-CT Analysis of Femoral Symmetry-Surgical Implications. J Clin Med 2020; 9:E3546. [PMID: 33153138 DOI: 10.3390/jcm9113546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment. METHODS Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was calculated and broken down into a rendering error and a manual overlay error. The Hausdorff-Besicovitch method was applied to obtain the total asymmetry. The manipulation error was theb subtracted from it to obtain the intrapersonal asymmetry. RESULTS The mean intrapersonal asymmetry was 0.93 mm. It was obtained by subtracting the error derived from rendering and alignment of 0.59 mm (SD 0.17 mm) from the overall mean error of 1.52 mm (SD 1.45). CONCLUSIONS Intrapersonal femoral asymmetry is low enough to use the mirror image of the healthy side as a reference for three-dimensional surgical planning. This type of planning is especially useful in deformity surgery when the objective of the surgery is not to restore only one specific parameter but to obtain a general functional morphology when a healthy contralateral femur is available.
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17
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Yan W, Xu X, Xu Q, Yan W, Sun Z, Jiang Q, Shi D. Femoral and tibial torsion measurements based on EOS imaging compared to 3D CT reconstruction measurements. Ann Transl Med 2019; 7:460. [PMID: 31700896 DOI: 10.21037/atm.2019.08.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The EOS imaging system is an advanced piece of equipment for full-body imaging, but its reliability and reproducibility should be further verified. Methods A prospective study was conducted including 18 adult volunteers (36 lower extremities) (24±2 years old). Femoral and tibial torsion were measured by both EOS imaging and three-dimensional computed tomography (3D CT) reconstruction. Bland-Altman plots were performed to evaluate the difference between femoral and tibial torsion measurements obtained by these two methods. The intraclass correlation coefficient (ICC) was used to evaluate intrareader agreement. Results The mean difference between the two methods was 3° (range, -9° to 4°) for femoral torsion, 0° (range, -6° to 6°) for tibial torsion and 0° (range, -4° to 5°) for femorotibial torsion. No statistically significant difference between the measurements of the two methods was detected by Bland-Altman plots. With the exception of one measurement of femoral torsion, one measurement of tibial torsion and one measurement of femorotibial torsion, all EOS imaging measurements were within the 95% limits of agreement (the mean ± 1.96 SD). Intrareader agreement was statistically significant (P<0.001) for all measurements, with high ICCs. For EOS imaging, the ICC was 0.92 for the femoral measurement, 0.92 for the tibial measurement and 0.918 for the femorotibial measurement; the corresponding values for CT were 0.950, 0.927 and 0.889. Conclusions There was good agreement between EOS imaging based and 3D CT reconstruction based technique in measuring femoral, tibial and femorotibial torsion; and good reliability and reproducibility of EOS Imaging in measuring femoral, tibial and femorotibial torsion was also verified.
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Affiliation(s)
- Wenqiang Yan
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qian Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Wenjin Yan
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Ziying Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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Fritz B, Bensler S, Leunig M, Zingg PO, Pfirrmann CWA, Sutter R. MRI Assessment of Supra- and Infratrochanteric Femoral Torsion: Association With Femoroacetabular Impingement and Hip Dysplasia. AJR Am J Roentgenol 2018; 211:155-61. [PMID: 29733696 DOI: 10.2214/AJR.17.18882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate a novel measurement technique for assessing the supra- and infratrochanteric components of femoral torsion, establish reference values in healthy volunteers, and compare supra- and infratrochanteric torsion angles in patients with hip dysplasia and patients with femoroacetabular impingement (FAI) with those in healthy volunteers. MATERIALS AND METHODS Femoral torsion was assessed in 380 patients and 61 healthy volunteers on MRI. For assessing supra- and infratrochanteric torsion, three measurement techniques (i.e., Kim, simplified Kim, and centroid methods) were evaluated by two readers on 100 patients. The technique with the highest interreader reliability was selected to perform measurements on all patients and volunteers. Supra- and infratrochanteric torsion angles of patients were stratified by hip disorders, which were diagnosed by specialized hip surgeons, and were compared with reference values of healthy volunteers. Statistical analysis included the independent t test, Mann-Whitney U test, and intraclass correlation coefficient (ICC). RESULTS The centroid method showed the highest interreader reliability for measuring supra-and infratrochanteric torsion with an ICC of 0.979. The supra- and infratrochanteric torsion values of the volunteers were 31.5° ± 7.4° (mean ± SD) and -18.3° ± 9.9°, respectively. In comparison with the volunteers, patients with hip dysplasia had significantly higher supraand infratrochanteric torsion values of 37.5° ± 10.3° (p = 0.001) and -9.6° ± 11.7° (p < 0.001) and patients with pincer-type FAI had significantly higher supratrochanteric torsion values of 37.8° ± 8.0° (p = 0.002). CONCLUSION The supra- and infratrochanteric components of femoral torsion differ substantially between hip disorders: Patients with hip dysplasia have predominantly increased infratrochanteric torsion, whereas patients with pincer-type FAI have increased supratrochanteric torsion. Quantification of separate supra- and infratrochanteric torsion angles allows a more detailed analysis of hip disorders and may influence treatment planning.
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Martin HD. CORR Insights(®): The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia? Clin Orthop Relat Res 2017; 475:870-1. [PMID: 28054324 DOI: 10.1007/s11999-016-5207-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/12/2016] [Indexed: 01/31/2023]
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Boissonneault AR, Hiranaka T, Roberson JR, Bradbury TL. A Validated Single-View Radiographic Alternative to Computed Tomography for the Measurement of Femoral Anteversion: A Method-Comparison Study. J Arthroplasty 2017; 32:1018-23. [PMID: 27816368 DOI: 10.1016/j.arth.2016.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/15/2016] [Accepted: 09/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although preoperative templating in total hip arthroplasty is helpful to ensure appropriate component position, there is no single-view radiographic method to determine femoral anteversion (FA) preoperatively. The aim of the present study was to validate the use of radiographic measurement of FA using a modified Budin view. METHODS This prospective study reports on 105 limbs from 65 patients. Computed tomography (CT) scans and radiographs were obtained to measure native FA. Radiographs were obtained using the modified Budin protocol with 90° flexion at the knee and 90° flexion and 30° abduction at the hip. Pearson correlation analyses, paired-samples t-test, and Bland-Altman plots were performed to assess correlation and agreement between methods. Data were grouped into subsets based on CT-derived FA in 5° intervals. Groups included all limbs, FA < 35°, FA < 30°, and FA < 25°. RESULTS For all limbs, Bland-Altman analysis revealed a fixed bias (mean bias, -0.8°; 95% confidence interval, -1.4° to -0.2°) and showed that radiographic methods underestimated FA. Subset analyses were performed and revealed excellent correlation between CT and radiographic measurements for all subgroups (r = 0.97, P < .001). Paired-samples t-tests revealed no significant difference between methodologies for any of the subgroups. Radiographic and CT methods showed excellent agreement, and the bias between methods was within 0.5° for all subgroups. There was no fixed bias and thus no systematic difference in methods within any of the subgroup analyses. CONCLUSION Radiographic measurement of FA using a modified Budin view is a valid and reliable technique.
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Abstract
Context: Anterior knee pain (AKP) represents the most common reason to consult with a clinician who specializes in the knee. Despite the high incidence of the disorder, however, its etiology is still controversial. Many unnecessary surgeries that may damage the patient are done for this clinical entity. Evidence Acquisition: A PubMed search from 1995 through June 2016. Study Design: Clinical review. Level of Evidence: Level 4. Results: The etiology of AKP is multifactorial, and patients with AKP may therefore be divided into several subpopulations. The whole picture must be addressed for each patient to identify all potentially modifiable factors and to achieve better outcomes. Both pelvifemoral dysfunction and psychological factors that may affect the development and symptoms of AKP must be considered to identify therapeutic targets within the context of treatment. Patients presenting with AKP frequently respond well to load restriction that protects their knee and reduces pain during rehabilitation. Surgery should only be considered in very select cases. In a patient who has undergone previous patellar realignment surgery and experienced increased pain, iatrogenic medial patellar instability should be considered. Conclusions: The etiology of AKP is multifactorial, and several subpopulations of AKP patients exist and their treatment must be personalized. Normally, the focus is on the knee of a patient with AKP, and only that joint is examined. However, that focus can lead to overlooking other important etiological factors that may be present.
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Affiliation(s)
| | - Scott F Dye
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
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Souza AD, Ankolekar VH, Padmashali S, Das A, Souza A, Hosapatna M. Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages. Malays Orthop J 2015; 9:33-36. [PMID: 28435607 PMCID: PMC5333666 DOI: 10.5704/moj.1507.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/01/2015] [Indexed: 01/27/2023] Open
Abstract
Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.
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Affiliation(s)
- A D Souza
- Department of Anatomy, Kasturba Medical College, Manipal, India
| | - V H Ankolekar
- Department of Anatomy, Kasturba Medical College, Manipal, India
| | - S Padmashali
- Department of Anatomy, Kasturba Medical College, Manipal, India
| | - A Das
- Department of Anatomy, Kasturba Medical College, Manipal, India
| | - Asd Souza
- Department of Anatomy, Kasturba Medical College, Manipal, India
| | - M Hosapatna
- Department of Anatomy, Kasturba Medical College, Manipal, India
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Bruderer-Hofstetter M, Fenner V, Payne E, Zdenek K, Klima H, Wegener R. Gait deviations and compensations in pediatric patients with increased femoral torsion. J Orthop Res 2015; 33:155-62. [PMID: 25284013 DOI: 10.1002/jor.22746] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/02/2014] [Indexed: 02/04/2023]
Abstract
Coxa antetorta describes an abnormal torsion of the femur. It is commonly considered a cosmetic problem and is treated surgically only in severe cases and the presence of physical complaints. The purpose of this study was to identify deviations in gait kinematics and kinetics in pediatric patients caused by coxa antetorta and to categorize these deviations into primary and secondary deviations. We conducted a retrospective, cross-sectional three-dimensional (3D) gait analysis study to detect gait deviations in adolescents (n = 18; age range 10.5-17.5 years) with coxa antetorta compared to age-matched healthy control subjects (n = 17). Principal component (PC) analysis was used for data reduction. Linear mixed models applied to PC-scores were used to estimate the main effects within retained PCs followed by a post-hoc subgroup analysis. Patients walked with smaller external foot progression angle, greater knee adduction, more internally rotated and flexed hips and greater anterior pelvic tilt. Subgroup analysis revealed that-depending on knee alignment-patients had higher knee and hip adduction moments. These deviations in joint kinematics and kinetics may be associated with physical complaints and accelerated development of osteoarthritis. Assessment of gait deviations related to coxa antetorta using 3D gait analysis may be an additional tool in individual clinical decision-making.
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Affiliation(s)
- Marina Bruderer-Hofstetter
- Institute of Physiotherapy, School of Health Professions, University of Applied Sciences Zurich, Winterthur, Switzerland; Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Wescott DJ, Cunningham DL, Hunt DR. Temporal trends in femoral diaphyseal torsional asymmetry among the Arikara associated with postural behavior. Am J Phys Anthropol 2014; 154:512-24. [PMID: 24861881 DOI: 10.1002/ajpa.22541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/04/2014] [Accepted: 05/06/2014] [Indexed: 01/25/2023]
Abstract
Average femoral torsion has been reported to differ among populations, and several studies have observed a relatively high prevalence of femoral anteversion asymmetry in Native Americans, especially females. This study investigates sexual dimorphism and temporal trends in femoral torsional asymmetry among the Arikara from the seventeenth to the early nineteenth century. To establish if there are population differences, femoral torsion was first measured using a direct method on a diverse comparative sample of Native Americans from the Southwest, Midwest, and Great Plains as well as American Whites and Blacks. To examine temporal trends among the Arikara, femoral torsion was examined using the orientation of the maximum bending rigidity at subtrochanteric in 154 females and 164 males from three temporal variants of the Arikara Coalescent tradition. There is significant sexual dimorphism in femoral torsional directional and absolute asymmetry among most Native American samples, but not among American Whites and Blacks. Among the Arikara there is significant sexual dimorphism in femoral torsional asymmetry in all three temporal variants, and asymmetry in femoral torsional asymmetry increased significantly from the protohistoric to the early historic period among females. The increased femoral torsional asymmetry is likely associated with a common side-sitting posture observed in historic photographs of Great Plains females. Historic Arikara females may have habitually sat in this compulsory position for extended periods while conducting domestic chores. The dramatic change from the protohistoric to historic period suggests a cultural change in sitting posture among females that was widespread across the Northern Plains.
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Affiliation(s)
- Daniel J Wescott
- Department of Anthropology, Forensic Anthropology Center at Texas State, Texas State University, San Marcos, TX, 78666
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