Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory

Ferràs-Tarragó, Joan; Sanchis-Alfonso, Vicente; Ramírez-Fuentes, Cristina; Roselló-Añón, Alejandro; Baixauli-García, Francisco

doi:10.3390/jcm9123835

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Established treatment options for femoral torsional abnormalities are subtrochanteric and supracondylar rotational osteotomies [43], since the desired correction is achieved regardless of the osteotomy level [7,8]. However, the previous studies concluded that torsional osteotomies might induce an unintentional implication on the frontal plane alignment [31,39].…”

Section: Discussionmentioning

confidence: 99%

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

Flury

Hoch

Hodel

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting. Methods Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The inluence of morphologic factors of the femur [centrum-collum-diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated. Results Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10-17°). In the frontal plane, mLDFA changed a mean of 0.1° (− 0.06 to 0.3°) (n.s.) and − 0.3° (− 0.5 to − 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°-23°). mLDFA changed a mean of − 0.2° (− 0.5° to 0.2°) (p < 0.006) and 0.2° (0-0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (− 2.3 to 1.3) (p < 0.01) and 0.5° (− 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to inluence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001). Conclusions In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

Flury

Hoch

Hodel

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…By using three-dimensional finite element method, Liska et al [16] analyzed the change of pressure on patellofemoral joint caused by the increased femoral anteversion. Ferràs-Tarragó et al [17] conducted the three-dimensional finite element analysis and found that final femoral anteversion would not be affected as long as the osteotomy plane was perpendicular to the femoral shaft. However, instead of considering possible malformation of the femoral condyle in patients with patellar dislocation, all these authors only increased the angle of the overall femoral torsion by simulations.…”

Section: Discussionmentioning

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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“…PFPS is a disease that can affect different population groups and occurs due to multiple factors [ 10 , 11 , 12 ], such as: Movement-related factors: Tasks performed with knee flexion above 60° and knee movement ahead of toes [ 10 , 13 , 14 ]. Individual factors: Bone misalignments with little evidence [ 7 , 15 , 16 ] and muscle imbalances, increased strength of the hamstrings relative to the quadriceps, as well as anserine paw tendinopathy [ 15 , 17 , 18 ], as weakness in the quadriceps [ 19 , 20 ] and increased strength in the hip abductor muscles compared to other thigh muscles [ 12 ]. Psychosocial factors: Anxiety and depression may be indirect risk factors for PFPS.…”

Section: Introductionmentioning

confidence: 99%

“…Individual factors: Bone misalignments with little evidence [ 7 , 15 , 16 ] and muscle imbalances, increased strength of the hamstrings relative to the quadriceps, as well as anserine paw tendinopathy [ 15 , 17 , 18 ], as weakness in the quadriceps [ 19 , 20 ] and increased strength in the hip abductor muscles compared to other thigh muscles [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review

Pereira

Baptista

Conceição

et al. 2022

IJERPH

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Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.

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Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory

Cited by 10 publications

References 14 publications

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

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

Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review

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