Skeletal Radiol (1992) 21:311-313
Skeletal Radiology
Patellofemoral characteristics in patients with increased femoral anteversion Olav Reikerhs, M.D. Institute of Clinical Medicine, Department of Orthopaedics, University Hospital, N-9038 Tromso, Norway
Abstract. In this study, the a s s o c i a t i o n b e t w e e n i n c r e a s e d f e m o r a l a n t e v e r s i o n a n d the c h a r a c t e r i s t i c s o f the p a t e l l o f e m o r a l j o i n t was i n v e s t i g a t e d in adults. In 17 female c o n t r o l p a t i e n t s , the a n t e v e r s i o n angle o f the f e m o r a l neck m e a s u r e d 12~ ~ a n d 11~ ~ for the r i g h t a n d left side, respectively. T h e sulcus anglc o f the p a t e l l o f c moral joint was 145~ ~ a n d 146~ ~, the c o n g r u e n c e angle 7.2~ - 14 ~ a n d 7.8~ 15 ~ a n d the lateral p a t e l l o f e m o r a l angle 5.9 ~ _+ 6 ~ a n d 5.7 ~ _+ 6 ~ respectively. In 15 female p a t i e n t s w h o were e v a l u a t e d for clinical s y m p t o m s o f i n c r e a s e d f e m o r a l a n t e v e r s i o n , the a n t e v e r sion angle o f the f e m o r a l neck was 30~ ~ a n d 31~ 8 ~ degrees for the right a n d left side, respectively. T h e sulcus angle was 143~ ~ a n d 147~ ~ the c o n g r u e n c e angle 7.3~ 12 ~ a n d 7.1~ 13 ~ a n d the l a t e r a l p a t e l l o f e m o r a l angle 6.4~ ~ a n d 6.1~ ~, respectively. T h e r e was n o c o r r e l a t i o n b e t w e e n the degree o f f e m o r a l a n t e v e r s i o n a n d the indices o f the p a t e l l o f e m o r a l r e l a t i o n ships. Thus, this s t u d y i n d i c a t e s t h a t there is n o association b e t w e e n i n c r e a s e d f e m o r a l a n t e v e r s i o n a n d a b n o r m a l p a t e l l o f e m o r a l characteristics. Key words: P a t e l l o f e m o r a l j o i n t - F e m o r a l a n t e v e r s i o n
I n - t o e i n g is a c o m m o n o r t h o p e d i c c o n d i t i o n . In m o s t cases, it is c a u s e d b y i n c r e a s e d f e m o r a l a n t e v e r s i o n w h i c h is a s s o c i a t e d with i n c r e a s e d i n t e r n a l a n d d e c r e a s e d e x t e r n a l r o t a t i o n o f the hips [14, 18, 19]. To o b t a i n the c o r r e c t f o o t p o s i t i o n while w a l k i n g , these i n d i v i d u a l s try to r o t a t e their legs o u t w a r d as far as p o s s i b l e [4, 17]. It has been s u g g e s t e d t h a t this m a y l e a d to m a l a l i g n m e n t o f the e x t e n s o r m e c h a n i s m w i t h a n a d v e r s e effect o n the knee f u n c t i o n [2, 20]. C o n s e q u e n t l y , the p r e s e n t s t u d y was devised to investigate w h e t h e r o r n o t i n c r e a s e d f e m o r a l a n t e v e r s i o n is a s s o c i a t e d w i t h a b n o r m a l p a t e l l o femoral relationships.
Patients and methods The study included 32 women, 17 control patients and 15 patients with increased femoral anteversion. The control patients all had been referred for examination by computed tomography (CT) for various pelvic disorders, and all gave their informed consent for additional scanning of the hips and knees. The mean age of the control patients was 32 years, with a range from 19 to 52 years. The patients with increased femoral anteversion were all examined by CT because of clinical signs of in-toeing with increased internal and restricted external rotation of the hips. None of the patients had specific symptoms of anterior knee pain or patellar instability. The mean age in this group was 24 years, with a range from 18 to 33 years. All the women were examined in the supine position with the hips and knees fully extended and the lower limbs horizontal and parallel. A series of CT scans was obtained through the hip and patellofemoral joints. The anteversion (AV) angle of the femoral neck was measured on three superimposed tomograms: one through the middle of the femoral head, one through the middle of the femoral neck, and one through the middle of the femoral condyles. The AV angle was measured as the angle between the line drawn from the center of the femoral head to the center of the femoral neck and the tangential line to the dorsal aspects of the femoral condyles [15] (Fig. l), The patellofemoral characteristics were determined on a scan through the middle of the patella. The sulcus angle of the femoral condyles was measured according to the method of Brattstr6m [1], the congruence anglc according to Merchant et al. [12], and the lateral patellofemoral angle according to Laurin et al. [10] (Fig. 1). Data are expressed as mean_+ standard deviation (SD). Statistical evaluations were performed by two-tailed t-test and by calculating the product moment correlation coefficient. P
Skeletal Radiology
Patellofemoral characteristics in patients with increased femoral anteversion Olav Reikerhs, M.D. Institute of Clinical Medicine, Department of Orthopaedics, University Hospital, N-9038 Tromso, Norway
Abstract. In this study, the a s s o c i a t i o n b e t w e e n i n c r e a s e d f e m o r a l a n t e v e r s i o n a n d the c h a r a c t e r i s t i c s o f the p a t e l l o f e m o r a l j o i n t was i n v e s t i g a t e d in adults. In 17 female c o n t r o l p a t i e n t s , the a n t e v e r s i o n angle o f the f e m o r a l neck m e a s u r e d 12~ ~ a n d 11~ ~ for the r i g h t a n d left side, respectively. T h e sulcus anglc o f the p a t e l l o f c moral joint was 145~ ~ a n d 146~ ~, the c o n g r u e n c e angle 7.2~ - 14 ~ a n d 7.8~ 15 ~ a n d the lateral p a t e l l o f e m o r a l angle 5.9 ~ _+ 6 ~ a n d 5.7 ~ _+ 6 ~ respectively. In 15 female p a t i e n t s w h o were e v a l u a t e d for clinical s y m p t o m s o f i n c r e a s e d f e m o r a l a n t e v e r s i o n , the a n t e v e r sion angle o f the f e m o r a l neck was 30~ ~ a n d 31~ 8 ~ degrees for the right a n d left side, respectively. T h e sulcus angle was 143~ ~ a n d 147~ ~ the c o n g r u e n c e angle 7.3~ 12 ~ a n d 7.1~ 13 ~ a n d the l a t e r a l p a t e l l o f e m o r a l angle 6.4~ ~ a n d 6.1~ ~, respectively. T h e r e was n o c o r r e l a t i o n b e t w e e n the degree o f f e m o r a l a n t e v e r s i o n a n d the indices o f the p a t e l l o f e m o r a l r e l a t i o n ships. Thus, this s t u d y i n d i c a t e s t h a t there is n o association b e t w e e n i n c r e a s e d f e m o r a l a n t e v e r s i o n a n d a b n o r m a l p a t e l l o f e m o r a l characteristics. Key words: P a t e l l o f e m o r a l j o i n t - F e m o r a l a n t e v e r s i o n
I n - t o e i n g is a c o m m o n o r t h o p e d i c c o n d i t i o n . In m o s t cases, it is c a u s e d b y i n c r e a s e d f e m o r a l a n t e v e r s i o n w h i c h is a s s o c i a t e d with i n c r e a s e d i n t e r n a l a n d d e c r e a s e d e x t e r n a l r o t a t i o n o f the hips [14, 18, 19]. To o b t a i n the c o r r e c t f o o t p o s i t i o n while w a l k i n g , these i n d i v i d u a l s try to r o t a t e their legs o u t w a r d as far as p o s s i b l e [4, 17]. It has been s u g g e s t e d t h a t this m a y l e a d to m a l a l i g n m e n t o f the e x t e n s o r m e c h a n i s m w i t h a n a d v e r s e effect o n the knee f u n c t i o n [2, 20]. C o n s e q u e n t l y , the p r e s e n t s t u d y was devised to investigate w h e t h e r o r n o t i n c r e a s e d f e m o r a l a n t e v e r s i o n is a s s o c i a t e d w i t h a b n o r m a l p a t e l l o femoral relationships.
Patients and methods The study included 32 women, 17 control patients and 15 patients with increased femoral anteversion. The control patients all had been referred for examination by computed tomography (CT) for various pelvic disorders, and all gave their informed consent for additional scanning of the hips and knees. The mean age of the control patients was 32 years, with a range from 19 to 52 years. The patients with increased femoral anteversion were all examined by CT because of clinical signs of in-toeing with increased internal and restricted external rotation of the hips. None of the patients had specific symptoms of anterior knee pain or patellar instability. The mean age in this group was 24 years, with a range from 18 to 33 years. All the women were examined in the supine position with the hips and knees fully extended and the lower limbs horizontal and parallel. A series of CT scans was obtained through the hip and patellofemoral joints. The anteversion (AV) angle of the femoral neck was measured on three superimposed tomograms: one through the middle of the femoral head, one through the middle of the femoral neck, and one through the middle of the femoral condyles. The AV angle was measured as the angle between the line drawn from the center of the femoral head to the center of the femoral neck and the tangential line to the dorsal aspects of the femoral condyles [15] (Fig. l), The patellofemoral characteristics were determined on a scan through the middle of the patella. The sulcus angle of the femoral condyles was measured according to the method of Brattstr6m [1], the congruence anglc according to Merchant et al. [12], and the lateral patellofemoral angle according to Laurin et al. [10] (Fig. 1). Data are expressed as mean_+ standard deviation (SD). Statistical evaluations were performed by two-tailed t-test and by calculating the product moment correlation coefficient. P
