Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur.

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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%. CONCLUSION: 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.

Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur / A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur

Introducción y objetivos: La medición precisa de la torsión femoral es esencial para el diagnóstico, indicación y planificación preoperatoria de las osteotomías desrotadoras femorales en pacientes con inestabilidad patelofemoral o dolor anterior de rodilla. Se han descrito múltiples métodos de medición, con valores muy diferentes entre ellos y ninguno de ellos permite establecer la magnitud de la osteotomía necesaria para devolver la torsión a valores normales. El objetivo del presente trabajo es desarrollar un método de medición que permita no solo el diagnóstico de pacientes con alteraciones torsionales, sino también establecer la magnitud de la osteotomía necesaria durante la cirugía. Material y métodos: Se seleccionaron 30 pacientes sin antecedentes de patología patelofemoral que disponían de una tomografía completa de miembros inferiores por otros motivos, siendo considerados así pacientes normales. Se calculó su torsión femoral mediante los métodos de Jeanmart y de Murphy por dos radiólogos independientes. Por otra parte, dos cirujanos ortopédicos independientes realizaron la medición de la torsión mediante el método 3D propuesto. Se evaluó el comportamiento normal de los datos y se definió la variabilidad intra- e interobservador del método 3D mediante su coeficiente de correlación intraclase y mediante el gráfico de Bland-Altman, realizando una comparación cuantitativa y cualitativa respectivamente con los métodos clásicos. Se estableció el intervalo de confianza de los valores normales con el nuevo método 3D y finalmente, se analizó al patrón de regresión lineal entre los métodos de Jeanmart y Murphy con el método de medición 3D. Resultados: La media de torsión femoral con el método 3D fue de 12,74° (DE 5,96°, IC 95%: 11,67 a 13,82°). Con el método de Jeanmart, esta fue de 12,84° (DE 8,60°, IC 95%: 11,28 a 14,39°) y de 15,87° (DE 10,68°, IC 95%: 13,94 a 17,80°) con el método de Murphy.(AU)

Introduction and objectives: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. Material and methods: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland–Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. Results: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high.(AU)

[Translated article] A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67°-13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28°-14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94°-17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programmes what makes its implementation in the healthcare centres possible from now on.

The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: a systematic review with meta-analysis.

PURPOSE: To quantify the risk of perioperative and postoperative complications of derotational femoral and/or tibial osteotomies in patellofemoral disorders (anterior knee pain and patellar instability) in adolescents and active young patients. METHODS: MEDLINE, EMBASE, Cochrane and Scopus databases were used to identify studies published from database inception and June 30, 2021. Meta-analysis was performed to pool the rates of complications related to femur and tibia osteotomies. Values of proportion of complications were expressed as proportions and 95% confidence intervals (CI) and then transformed using a Freeman Tukey double arcsine transformation. Meta-regression was used to explore factors that potentially may influence on heterogeneity such as year of publication, quality of the included studies and site of the osteotomy. RESULTS: The 22 studies identified included a total of 648 derotational osteotomies in 494 patients. Studies consisted of 20 case series (non-comparative) and 2 comparative observational non-randomized cohorts. Tibial osteotomies showed higher risk of complications than femoral osteotomies (random pooled prevalence 9%; 95% CI 4-15% versus 1%; 95% CI 0-5%, respectively, p < 0.01). The meta-regression analysis of the articles showed that the only parameters responsible of the variance in number of complications were the osteotomy site. CONCLUSIONS: Derotational femoral and/or tibial osteotomy is a safe surgical procedure in the treatment of patellofemoral disorders (anterior knee pain and patellar instability) in adolescents and active young people. LEVEL OF EVIDENCE: IV.

A 3D method to estimate the effect of derotational osteotomies over femoral maltorsion. / Un método 3D para estimar el efecto de osteotomías desrotadoras sobre alteraciones torsionales de fémur.

INTRODUCTION AND OBJECTIVES: Accurate measurement of femoral torsion is essential to diagnosing, correct surgical decision-making, and the preoperative planning of derotational osteotomies in a subgroup of anterior knee pain patients and patellofemoral instability. Several measurement techniques have been described with great variability in the magnitude of the values. Moreover, none of them can predict the effect of rotational osteotomy on the femoral version value. The purpose of the present work is to develop a method to reliably measure femoral torsion as well as to evaluate the effects of osteotomy on the femoral version angle. MATERIAL AND METHODS: 30 patients without previous signs neither symptoms of patellofemoral pain or patellofemoral instability and with a lower limbs CT were selected. Their femoral torsion was measured using the classic Jeanmart and the Murphy's method by two independent radiologists. Independently, two orthopedic surgeons measured femoral torsion with the 3D method described in this study. The intraclass coefficient correlation and the Bland-Altman tests were used to analyze qualitatively and quantitatively the intraobserver and interobserver variability of the method regarding the Jeanmart's and Murphy's method. The confidence interval of the Normal values of the new method were defined and a lineal regression analysis between the 3D-Jeanmart's and 3D-Muphy's methods was performed. RESULTS: The mean femoral version with the 3D method was 12.74° (SD 5.96°, 95% CI: 11.67° to 13.82°). With Jeanmart's method, it was 12.84° (SD 8.60°, 95% CI: 11.28° to 14.39°) and 15.87° (SD 10.68°, 95% CI: 13.94° to 17.80°) with Murphy's method, being these differences not statistically significant. Both interobserver and intraobserver agreement of the 3D method were high. CONCLUSION: The method presented in this study allows for the reliable quantification of femoral torsion in a reproducible way. This method can be applied in several open access 3D image programs what makes its implementation in the healthcare centers possible from now on.

A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

BACKGROUND: Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment. METHODS: Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was calculated and broken down into a rendering error and a manual overlay error. The Hausdorff-Besicovitch method was applied to obtain the total asymmetry. The manipulation error was theb subtracted from it to obtain the intrapersonal asymmetry. RESULTS: The mean intrapersonal asymmetry was 0.93 mm. It was obtained by subtracting the error derived from rendering and alignment of 0.59 mm (SD 0.17 mm) from the overall mean error of 1.52 mm (SD 1.45). CONCLUSIONS: Intrapersonal femoral asymmetry is low enough to use the mirror image of the healthy side as a reference for three-dimensional surgical planning. This type of planning is especially useful in deformity surgery when the objective of the surgery is not to restore only one specific parameter but to obtain a general functional morphology when a healthy contralateral femur is available.