High prevalence of femoral and tibial torsional abnormalities in female patients with anterior knee pain resistant to conservative treatment: A CT-based study

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-27 DOI:10.1002/jeo2.70446

Vicente Sanchis-Alfonso, Cristina Ramírez-Fuentes, Erik Montesinos-Berry, Julio Doménech-Fernández

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Abstract

Purpose

To assess acetabular version (AV) and to determine the prevalence of femoral and tibial torsional abnormalities in female patients with anterior knee pain (AKP) unresponsive to conservative treatment. The study also aimed to evaluate the prevalence of combined abnormalities.

Methods

Seventy-three AKP female patients resistant to conservative treatment evaluated between 2013 and 2024 were included. Torsional computed tomography (CT) of the lower limbs was performed on all cases, resulting in the evaluation of 146 limbs. Femoral anteversion (FAV) was measured using Murphy's method, external tibial torsion (ETT) using Jend's technique and AV using the method described by Tönnis and Heinecke.

Results

Torsional abnormalities were highly prevalent. Only 13.0% of limbs had normal ETT, 43.2% showed moderate abnormalities and 43.8% severe abnormalities. FAV was within normal limits in 48.6% of cases, while 26.7% had moderate anteversion, 22.6% severe anteversion and 2.1% retroversion. AV was normal in 82.9% of limbs, with 13.7% showing retroversion and 3.4% anteversion. Only 4.1% of patients exhibited normal across all three parameters, while 8.2% presented combined abnormalities. The most common paired association was observed for ETT and FAV (35.6%). Chi-squared analyses did not reveal statistically significant associations among the degrees of deformity. Pearson correlation analysis showed a weak but statistically significant correlation between ETT and FAV (r = 0.176, p = 0.034).

Conclusion

In young female patients with AKP unresponsive to conservative treatment, assessment of femoral and tibial torsion using CT imaging should be systematically considered. This approach is essential for guiding clinical decision-making. The range of possible torsional abnormalities highlights the importance of patient-specific evaluation.

Level of Evidence

Level IV.

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一项基于ct的研究：保守治疗抵抗的女性前膝关节疼痛患者股骨和胫骨扭转异常的高发率

目的评估髋臼变形（AV），并确定对保守治疗无反应的女性前膝疼痛（AKP）患者股骨和胫骨扭转异常的发生率。该研究还旨在评估合并异常的患病率。方法纳入2013 ~ 2024年对73例AKP女性保守治疗患者进行评价。所有病例均行下肢扭转CT，对146条肢体进行评估。股骨前倾（FAV）采用Murphy's法测量，胫骨外扭转（ETT）采用Jend's法测量，AV采用Tönnis和Heinecke描述的方法测量。结果扭转异常非常普遍。仅13.0%的肢体ETT正常，43.2%为中度异常，43.8%为重度异常。48.6%的FAV在正常范围内，中度前倾26.7%，重度前倾22.6%，前倾2.1%。82.9%的肢体AV正常，其中13.7%为后倾，3.4%为前倾。只有4.1%的患者在所有三个参数中表现正常，而8.2%的患者出现联合异常。最常见的配对关联是ETT和FAV（35.6%）。卡方分析没有显示畸形程度之间有统计学意义的关联。Pearson相关分析显示ETT与FAV的相关性较弱，但有统计学意义（r = 0.176, p = 0.034）。结论对于保守治疗无效的年轻女性AKP患者，应系统考虑CT对股骨和胫骨扭转的评估。这种方法对指导临床决策至关重要。可能扭转异常的范围突出了患者特异性评估的重要性。证据等级四级。

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