Femoral anteversion measured by the surgical transepicondylar axis is a reliable parameter for evaluating femoral rotational deformities in patients with patellar dislocation

Chen, Jiaxing; Yin, Baoshan; Yao, Jinjiang; Zhou, Yong‐Wu; Zhang, Hua; Zhang, Jian; Zhou, Aiguo

doi:10.1007/s00167-022-07016-0

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…Recent studies by Zhao et al found that the main contributors to increased femoral anteversion in patients with patellar dislocation were the middle and distal femur [6], and other authors also discovered that the leading contributors to increased femoral anteversion were the middle and distal femur [7,8]. Chang and Li et al found that patients with severe valgus knees had greater femoral anteversion and dysplasia of the posterolateral condyle was also a key cause of femoral anteversion [9,10].…”

Section: Introductionmentioning

confidence: 99%

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

Fan

Niu

Wei

et al. 2023

BMC Musculoskelet Disord

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Purpose Distal femoral torsion is a key factor for poor alignment of patellofemoral joint. This study aims to evaluate the correlation between distal femoral torsion and the severity of patellofemoral arthritis, and to analyze the correlation between distal femoral torsion and the morphology of femoral condyle. Methods A retrospective analysis was performed on 125 patients awaiting surgical treatment for knee osteoarthritis from January 2021 to March 2022(79 females, 46 males, average age: 65.78 years, SD 6.61). All patients underwent knee joint radiography, lower-limb digital radiography, and knee joint CT scans. The ratio of length of each distal femoral condyle, TT-TG, patellar tilt, DFL-PCL, DFL-TEA, TEA-PCL and TEA-ACL were measured. The Pearson correlation coefficient was used to evaluate the correlation between distal femoral torsion and ratio of distal femoral condyle, TT-TG and patellar tilt. Logistic regression was used to evaluate the correlation between each parameter and the severity of PFOA. Results With the increased severity of PFOA, TT-TG, patellar tilt, DFL-PCL, DFL-TEA and PCA all tended to increase. Patellar tilt was correlated with DFL-PCL (r = 0.243) and TEA-PCL(r = 0.201), but TT-TG had no evident correlation with distal femoral torsion. Compared with Grade I patients of PFOA, DFL-PCL, DFL-TEA, and TEA-PCL were risk factors for increased severity of patellofemoral arthritis in Grade III patients of PFOA, but there was no significant statistic difference in Grade II patients of PFOA. Conclusions Distal femoral torsion correlates with the severity of patellofemoral arthritis. Variation of the femoral transepicondylar axis caused by the change of ratio of the femoral condyle is particularly important in the distal femoral torsion. In patients with severe PFOA, abnormal variation of the femoral condyle axis should be not ignored.

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Section: Introductionmentioning

confidence: 99%

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

Fan

Niu

Wei

et al. 2023

BMC Musculoskelet Disord

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“…In 2022, a systematic review highlighted the importance of an accurate radiological evaluation to perform an individualized surgical strategy [ 8 ]. Using the posterior condylar reference line (P-tAV) to measure femoral anteversion cannot allow an accurate evaluation of the rotational malformation due to the influence of posterior femoral condylar dysplasia; the surgical transepicondylar axis (SEA) serves as a more appropriate reference line for evaluating femoral anteversion (S-tAV) [ 9 ]. The morphologies of the posterior femoral condyles rarely influence the measurement of S-tAV, with a value of >20.4° indicating pathology.…”

Section: Introductionmentioning

confidence: 99%

Femoral Anteversion Measured by the Surgical Transepicondylar Axis Is Correlated with the Tibial Tubercle–Roman Arch Distance in Patients with Lateral Patellar Dislocation

Chen

Fan

et al. 2023

Medicina

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Background and Objectives: Various predisposing factors for lateral patellar dislocation (LPD) have been identified, but the relation between femoral rotational deformity and the tibial tubercle–Roman arch (TT-RA) distance remains elusive. Materials and Methods: We conducted this study including 72 consecutive patients with unilateral LPD. Femoral anteversion was measured by the surgical transepicondylar axis (S-tAV), and the posterior condylar reference line (P-tAV), TT-RA distance, trochlear dysplasia, knee joint rotation, patellar height, and hip–knee–ankle angle were measured by CT images or by radiographs. The correlations among these parameters were analyzed, and the parameters were compared between patients with and without a pathological TT-RA distance. Binary regression analysis was performed, and receiver operating characteristic curves were obtained. Results: The TT-RA distance was correlated with S-tAV (r = 0.360, p = 0.002), but the correlation between P-tAV and the TT-RA distance was not significant. S-tAV had an AUC of 0.711 for predicting a pathological TT-RA, with a value of >18.6° indicating 54.8% sensitivity and 82.9% specificity. S-tAV revealed an OR of 1.13 (95% CI [1.04, 1.22], p = 0.003) with regard to the pathological TT-RA distance by an adjusted regression model. Conclusions: S-tAV was significantly correlated with the TT-RA distance, with a correlation coefficient of 0.360, and was identified as an independent risk factor for a pathological TT-RA distance. However, the TT-RA distance was found to be independent of P-tAV.

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“…To determine the ideal segment for performing femoral osteotomy, many authors have recently evaluated the position of the increased femoral anteversion. It has been found that the increased of the femoral shaft and distal femoral torsion is most noticeable in patients with patellar dislocation [1,[7][8][9]. However, many authors previously found that patients with patellar dislocation often developed bone malformations of the femoral condyle [10][11][12][13], and therefore, bone malformations of the distal femur is likely to result in internal torsion of the distal femur.…”

Section: Introductionmentioning

confidence: 99%

“…However, no consensus has been reached on the threshold of correction of femoral anteversion. Several scholars have reported that torsional deformity of femoral shaft plays a major role in the femoral torsion, while torsion of distal femur plays a minor role [1,7,9]. It has not yet been reported whether local torsion of distal femur is an independent risk factor for patellar dislocation in patients with patellar dislocation but free of significant femoral anteversion.…”

Section: Introductionmentioning

confidence: 99%

Local torsion of distal femur is a risk factor for patellar dislocation

2023

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Purpose It has been widely reported that femoral anteversion is a risk factor for patellar dislocation. This study aims to evaluate whether internal torsion of the distal femur is noticeable in patients without increased femoral anteversion and to assess whether it is a risk factor for patellar dislocation. Methods A retrospective analysis was conducted on 35 patients (24 females, 11 males) with recurrent patellar dislocation but without increased femoral anteversion treated in our hospital from January 2019 to August 2020. All patients underwent knee X-rays, digital radiography of lower-limbs, and CT scans of hip, knee, and ankle joints to measure femoral anteversion angle, distal femoral torsion angle, TT–TG and Caton-Deschamps index. Thirty-five control cases were matched on age and sex to compare the difference of anatomic parameters between the two groups, and the logistic analysis was used to analyze risk factors for patellar dislocation. Perman correlation coefficient was used to evaluate the correlation among femoral anteversion, distal femoral torsion and TT–TG. Results Greater distal femoral torsion was still observed in patients with patellar dislocation but without increased femoral anteversion. The torsion angle of distal femur, TT–TG distance and incidence of Patella Alta in patients with patellar dislocation were greater than those in control group, and the inter-group differences were statistically significant (P < 0.05). The torsion angle of distal femur (OR = 2.848, P < 0.001), TT–TG distance (OR = 1.163, P = 0.021) and Patella Alta (OR = 3.545, P = 0.034) were risk factors for patellar dislocation. However, no significant correlation was found among femoral anteversion, distal femoral torsion and TT–TG in patients with patellar dislocation. Conclusion On the condition that femoral anteversion did not increase, increased distal femoral torsion was commonly observed in patients with patellar dislocation, which represents an independent risk factor for patellar dislocation.

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Femoral anteversion measured by the surgical transepicondylar axis is a reliable parameter for evaluating femoral rotational deformities in patients with patellar dislocation

Cited by 16 publications

References 29 publications

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

Femoral Anteversion Measured by the Surgical Transepicondylar Axis Is Correlated with the Tibial Tubercle–Roman Arch Distance in Patients with Lateral Patellar Dislocation

Local torsion of distal femur is a risk factor for patellar dislocation

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