The impact of increased femoral antetorsion on gait deviations in healthy adolescents.

Increased femoral antetorsion leads to several gait deviations, and amongst others, an increased knee flexion was reported in mid and terminal stance. Therefore, the purpose of this retrospective study was to identify gait deviations caused by increased femoral antetorsion and to perform subgroup analyses based on sagittal knee kinematics. Patients with isolated, CT confirmed increased femoral antetorsion (n = 42) and age-matched typically developing children (TDC, n = 17) were included in this study. Patients were referred to gait analysis because of gait abnormalities going along with an increased femoral antetorsion ≥30°. Kinematic and kinetic data were recorded during 3D gait analysis and three valid gait cycles were analyzed. Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the group effect of PC-scores of retained PCs explaining 90% of the cumulative variance. Group effects of PC-scores revealed that patients walked with more flexed hips and greater anterior pelvic tilt throughout the gait cycle. Knee flexion was increased in patients during mid and terminal stance. Increased frontal plane knee and hip joint moments were found for patients compared to TDC. Furthermore, dividing patients into two subgroups based on their sagittal knee kinematics showed that kinematic gait deviations were more pronounced in patients with higher femoral antetorsion, while deviations in joint moments were more pronounced in patients with lower femoral antetorsion. Increased femoral antetorsion showed alterations in all lower limb joints and may be not only a cosmetic problem. Therefore, 3D gait analysis should be used for clinical management and operative treatment should be considered depending on severity of gait deviations.