Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain.
Department of Radiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain.
Arch Orthop Trauma Surg. 2024 Jan;144(1):51-57. doi: 10.1007/s00402-023-05036-0. Epub 2023 Aug 23.
Increased femoral anteversion (FAV) can have many clinical manifestations, including anterior knee pain (AKP). To our knowledge, no studies have measured the location of FAV in a cohort of female AKP patients. The objective of this research is to determine whether the increased FAV in AKP females originates above the lesser trochanter, below the lesser trochanter or at both levels.
Thrity-seven consecutive AKP female patients (n = 66 femurs) were recruited prospectively. There were 17 patients (n = 26 femurs; mean age of 28 years) in whom the suspicion for the increased FAV of the femur was based on the clinical examination (pathological group-PG). The control group (CG) consisted of 20 patients (n = 40 femurs; mean age of 29 years) in whom there was no increased FAV from the clinical standpoint. All of them underwent a torsional computed tomography of the lower limbs. FAV was measured according to Murphy´s method. A segmental analysis of FAV was performed using the lesser trochanter as a landmark.
Significant differences in the total FAV (18.7 ± 5.52 vs. 42.46 ± 6.33; p < 0.001), the neck version (54.88 ± 9.64 vs. 64.27 ± 11.25; p = 0.0006) and the diaphysis version (- 36.17 ± 8.93 vs. - 21.81 ± 11.73; p < 0.001) were observed between the CG and the PG. The difference in the diaphyseal angle between CG and PG accounts for 60% of the total difference between healthy and pathological groups, while the difference between both groups in the angle of the neck accounts for 40%.
In chronic AKP female patients with increased FAV, the two segments of the femur contribute to the total FAV, with a different pattern among patients and controls, being the compensation mechanism of the diaphysis much lower in the pathological femurs than in the controls.
股骨前倾角（FAV）增加可表现出多种临床症状，包括前膝痛（AKP）。据我们所知，目前尚无研究测量过女性 AKP 患者中 FAV 的位置。本研究旨在确定 AKP 女性患者的 FAV 是否增加起源于小转子上方、小转子下方或两者都有。
前瞻性纳入 37 例连续的 AKP 女性患者（n=66 条股骨）。其中 17 例（n=26 条股骨；平均年龄 28 岁）因临床检查怀疑股骨 FAV 增加（病理性组-PG）。对照组（CG）由 20 例患者（n=40 条股骨；平均年龄 29 岁）组成，从临床角度来看他们没有增加的 FAV。所有患者均行下肢扭转 CT 检查。FAV 采用 Murphy 法测量。以小转子为标志进行 FAV 节段分析。
CG 和 PG 之间的总 FAV（18.7±5.52 对 42.46±6.33；p<0.001）、颈倾角（54.88±9.64 对 64.27±11.25；p=0.0006）和骨干倾角（-36.17±8.93 对-21.81±11.73；p<0.001）存在显著差异。CG 和 PG 之间的骨干角差异占健康组和病理组总差异的 60%，而两组之间的颈角差异占 40%。
在患有增加的 FAV 的慢性 AKP 女性患者中，股骨的两个节段都对 FAV 有贡献，患者和对照组之间存在不同的模式，病理性股骨的骨干补偿机制明显低于对照组。
