Diminished Femoral Antetorsion Syndrome: A Cause of Pain and Osteoarthritis

Tönnis, Dietrich; Heinecke, Achim

doi:10.1097/01241398-199107000-00001

Cited by 151 publications

(120 citation statements)

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“…Patients with femoral retroversion also cannot tolerate the pain provoked by bringing the flexed knee to the chest [10], indicating positive anterior impingement [10], which is equivalent to the passive squatting test for frog-leg squatting. After reviewing the images and the literature, we suggest diminished femoral anteversion or femoral retroversion results in a smaller anterior space between the anterior acetabular rim and contact surface of the femoral headneck junction, restricting internal rotation, and a relative larger posterior space between the posterior acetabular rim and femur, allowing an increased capability of external rotation [1,7,12,13]. A reduction in anterior joint clearance subsequently potentiates early apposition and repetitive impaction of the anterior acetabular rim and femoral head-neck junction during hip flexion, adduction, or internal rotation, leading to early osteoarthritis [1,12,13].…”

Section: Discussionmentioning

confidence: 99%

“…After reviewing the images and the literature, we suggest diminished femoral anteversion or femoral retroversion results in a smaller anterior space between the anterior acetabular rim and contact surface of the femoral headneck junction, restricting internal rotation, and a relative larger posterior space between the posterior acetabular rim and femur, allowing an increased capability of external rotation [1,7,12,13]. A reduction in anterior joint clearance subsequently potentiates early apposition and repetitive impaction of the anterior acetabular rim and femoral head-neck junction during hip flexion, adduction, or internal rotation, leading to early osteoarthritis [1,12,13]. Twenty-two of our 67 patients (33%) with variable degrees of frog-leg squatting had aberrant femoral torsion with FAI rather than GMC.…”

Section: Discussionmentioning

confidence: 99%

“…Femoral anteversion refers to the condition where the femoral neck axis leans anterior to the transcondylar femoral axis. At birth, neonates have an average of 40°to 45°femoral anteversion [11,13], whereas by age 8 years, average anteversion decreases to the typical adult value of 15° [5,11,13]. If the anteversion angle is smaller than the average value for patients of the same age, it is termed diminished anteversion [13].…”

Section: Methodsmentioning

confidence: 99%

“…At birth, neonates have an average of 40°to 45°femoral anteversion [11,13], whereas by age 8 years, average anteversion decreases to the typical adult value of 15° [5,11,13]. If the anteversion angle is smaller than the average value for patients of the same age, it is termed diminished anteversion [13]. Femoral retroversion refers to the condition where the femoral neck axis is oriented posterior to the transcondylar axis, thus positioning the femoral neck and head posterior to the coronal plane of the femur.…”

Section: Methodsmentioning

confidence: 99%

“…The femoral neck axis of a normal healthy adult leans not only medially but also relatively anterior to the transcondylar axis by 15°, which is defined as anteversion [5,11]. In patients with aberrant femoral torsion, the femoral neck axis has a smaller than normal anteversion angle [13] or even retroversion when the femoral neck axis leans relatively posterior to the transcondylar axis [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Chiang

Tsai

Chang

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture.Questions/purposes We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting? Patients and Methods We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4-50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients. Results MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°-0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, \ 0°to À31°, average, À7.5°) in 29 femora of 17 patients. The remaining 18 (27%) patients did not have gluteal muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies. Conclusions In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting. Level of Evidence Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Chiang

Tsai

Chang

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Real time visualization of femoroacetabular impingement and subluxation using 320‐slice computed tomography

Wassilew

Janz

Heller

et al. 2012

Journal Orthopaedic Research

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We visualized extreme ranges of motion of the hip and located femoroacetabular impingement (FAI) and subluxations using 4dimensional (D) volume computed tomography (CT). In dynamic 4D CT, 30 patients with hip pain (>3 months) and positive clinical and radiological signs of impingement were prospectively analyzed. The investigations were performed in flexion, abduction, and external rotation. The accuracy of the CT visualization of FAI was compared with the intraoperative findings during surgical dislocation, which served as the gold standard. Compared to the intraoperative visualization of FAI, the dynamic CT images showed a high degree of accuracy. 4D CT is a suitable method to dynamically visualize the functional consequences of anatomical FAI pathologies. The location of impingement can be accurately determined, and when combined with information about possible labral tears and chondral damage supplied by magnetic resonance arthrography, allows the surgeon to select the optimal surgical access and plan the required operation for minimal invasiveness. ß

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In vivo test of a radiography‐based navigation system for control of derotational osteotomies

Grünwald

Schröter

Windolf

et al. 2020

Journal Orthopaedic Research

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Malalignment of the femur is a frequently encountered problem in orthopaedics entailing manifold consequences for the affected patients. Corrective osteotomies, necessary to restore the physiological and anatomical relationships, face great challenges due to no existing reliable gold standard for intraoperative control of torsional malalignment. The aim of this study was to test a novel radiography-based navigation tool for control of derotational osteotomies in a clinical environment. In a first-and preliminary-casecontrolled study on 12 patients (level 3 of evidence), the achieved torsional correction measured with implementation of the navigation tool was compared with measurements from pre-and postoperative computed tomography (CT) scans. The navigation tool was able to acquire and process all relevant data and capture possible malrotation during surgery with only little deviations of 1.61°± 0.86°(mean ± standard deviation) from the measurements based on CT scans. Next, the system will be used to assist surgeons for more precise treatment avoiding maltorsion after derotational osteotomies.

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Diminished Femoral Antetorsion Syndrome: A Cause of Pain and Osteoarthritis

Cited by 151 publications

References 10 publications

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Real time visualization of femoroacetabular impingement and subluxation using 320‐slice computed tomography

In vivo test of a radiography‐based navigation system for control of derotational osteotomies

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