Skip to main content
SpringerLink
Log in

Increased femoral anteversion related to infratrochanteric femoral torsion is associated with ACL rupture

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the association between femoral torsion and anterior cruciate ligament (ACL) rupture and determine the level of torsion using magnetic resonance imaging (MRI).

Methods

The medical records of patients who were diagnosed with ACL injury were reviewed retrospectively. This descriptive epidemiological study included 2344 patients. MRI scans were examined and patients with femur and knee MRI scans obtained at the same time were identified (ACL-deficient group). Twenty-eight of them had femur and knee MRI scans because of an incidental benign lesion in the distal femur. Patients who were diagnosed with enchondroma were followed up by MRI evaluation of the femur and were randomly selected as controls. Supratrochanteric torsion (STT), infratrochanteric torsion (ITT), and femoral anteversion (FA) were measured by orthopedic surgeons with at least 5 years of experience.

Results

Age, sex, and side properties were similar in both groups. The mean FA values were 19.4 ± 3.0 degrees and 11.9 ± 2.0 degrees in the ACL-deficient and control groups, respectively (p < 0.001). STT was similar in the ACL-deficient and control groups [mean: 38.2 ± 4.3 and 37.7 ± 3.3, respectively, (n.s.)]. ITT was increased in the ACL-deficient group compared with the control group (mean − 18.8 ± 4.3 and − 25.8 ± 3.8, respectively; p < 0.001).

Conclusions

According to our results, increased FA was associated with ACL rupture. Further, the torsional abnormality was developed from the ITT. We concluded that each ACL-deficient patient should be assessed by a clinician for torsional abnormality using physical examination.

Level of evidence

III

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amraee D, Alizadeh MH, Minoonejhad H, Razi M, Amraee GH (2017) Predictor factors for lower extremity malalignment and non-contact anterior cruciate ligament injuries in male athletes. Knee Surg Sports Traumatol Arthrosc 25(5):1625–1631

    Article  CAS  PubMed  Google Scholar 

  2. Beaulieu ML, Oh YK, Bedi A, Ashton-Miller JA, Wojtys EM (2014) Does limited internal femoral rotation increase peak anterior cruciate ligament strain during pivoted landing? Am J Sports Med 42(12):2955–2963

    Article  PubMed  PubMed Central  Google Scholar 

  3. Beebe MJ, Wylie JD, Bodine BG, Kapron AL, Maak TG, Mei-Dan O, Aoki SK (2017) Accuracy and reliability of computed tomography and magnetic resonance imaging compared with true anatomic femoral version. J Pediatr Orthop 37(4):e265–e270

    Article  PubMed  Google Scholar 

  4. Boszczyk A, Fudalej M, Kwapisz S, Klimek U, Maksymowicz M, Kordasiewicz B, Rammelt S (2018) Ankle fracture—correlation of Lauge-Hansen classification and patient reported fracture mechanism. Forensic Sci Int 282:94–100

    Article  PubMed  Google Scholar 

  5. Botser IB, Ozoude GC, Martin DE, Siddiqi AJ, Kuppuswami S, Domb BG (2012) Femoral anteversion in the hip: Comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Arthroscopy 28(5):619–627

    Article  PubMed  Google Scholar 

  6. Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22(8):894–899

    Article  PubMed  Google Scholar 

  7. Chaudhari AM, Andriacchi TP (2006) The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury. J Biomech 39(2):330–338

    Article  PubMed  Google Scholar 

  8. Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41(1):51–57

    Article  PubMed  Google Scholar 

  9. Faulks S, Brown K, Birch JG (2017) Spectrum of diagnosis and disposition of patients referred to a pediatric orthopaedic center for a diagnosis of intoeing. J Pediatr Orthop 37:e432–e435

    Article  PubMed  Google Scholar 

  10. Fritz B, Bensler S, Leunig M, Zingg PO, Pfirrmann CWA, Sutter R (2018) MRI assessment of supra- and infratrochanteric femoral torsion: association with femoroacetabular impingement and hip dysplasia. AJR Am J Roentgenol 211(1):155–161

    Article  PubMed  Google Scholar 

  11. Kaneko M, Sakuraba K (2013) Association between femoral anteversion and lower extremity posture upon single-leg landing: implications for anterior cruciate ligament injury. J Phys Ther Sci 25(10):1213–1217

    Article  PubMed  PubMed Central  Google Scholar 

  12. LaPrade RF, Burnett QM (1994) Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med 22(2):198–202

    Article  CAS  PubMed  Google Scholar 

  13. Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60(5):957–985

    Article  CAS  PubMed  Google Scholar 

  14. Maier C, Zingg P, Seifert B, Sutter R, Dora C (2012) Femoral torsion: reliability and validity of the trochanteric prominence angle test. Hip Int 22(5):534–538

    Article  PubMed  Google Scholar 

  15. Matovinović D, Nemec B, Gulan G, Sestan B, Ravlić-Gulan J (1998) Comparison in regression of femoral neck anteversion in children with normal, intoeing and outtoeing gait–prospective study. Coll Antropol 22(2):525–532

    PubMed  Google Scholar 

  16. Muhamad AR, Freitas JM, Bomar JD, Dwek J, Hosalkar HS (2012) CT and MRI lower extremity torsional profile studies: measurement reproducibility. J Child Orthop 6(5):391–396

    Article  PubMed  PubMed Central  Google Scholar 

  17. Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF (1992) Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics 12(5):901–915

    Article  CAS  PubMed  Google Scholar 

  18. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42(6):394–412

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sanders TG, Medynski MA, Feller JF, Lawhorn KW (2000) Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics 20:135–151

    Article  Google Scholar 

  20. Sankar WN, Neubuerger CO, Moseley CF (2009) Femoral anteversion in developmental dysplasia of the hip. J Pediatr Orthop 29(8):885–888

    Article  PubMed  Google Scholar 

  21. Shin C, Chaudhari AM, Andriacchi TP (2011) Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. Med Sci Sports Exerc 43(8):1484–1491

    Article  PubMed  Google Scholar 

  22. Shen X, Xiao J, Yang Y, Liu T, Chen S, Gao Z, Zuo J (2019) Multivariable analysis of anatomic risk factors for anterior cruciate ligament injury in active individuals. Arch Orthop Trauma Surg 139(9):1277–1285

    Article  PubMed  Google Scholar 

  23. Stride D, Wang J, Horner NS, Alolabi B, Khanna V, Khan M (2019) Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27(4):1320–1331

    Article  PubMed  Google Scholar 

  24. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW (2012) Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 263(2):475–483

    Article  PubMed  Google Scholar 

  25. Takagi S, Sato T, Watanabe S, Tanifuji O, Mochizuki T, Omori G, Endo N (2018) Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 26(10):2891–2898

    Article  PubMed  Google Scholar 

  26. Vasta S, Andrade R, Pereira R, Bastos R, Battaglia AG, Papalia R, Espregueira-Mendes J (2018) Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury. Knee Surg Sports Traumatol Arthrosc 26(9):2817–2825

    Article  PubMed  Google Scholar 

  27. Yu B, Lin CF, Garrett WE (2006) Lower extremity biomechanics during the landing of a stop-jump task. Clin Biomech (Bristol, Avon) 21(3):297–305

    Article  Google Scholar 

  28. Zhang L, Hacke JD, Garrett WE, Liu H, Yu B (2019) Bone bruises associated with anterior cruciate ligament injury as indicators of injury mechanism: a systematic review. Sports Med 49(3):453–462

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Sultanbeyli State Hospital, Battalgazi Mahallesi, Paşaköy Cd. No: 64, 34935, Sultanbeyli, Istanbul, Turkey

    Yakup Alpay

  2. Department of Orthopedics, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey

    Atakan Ezici, Muhammed Bilal Kurk, Osman Nuri Ozyalvac, Evren Akpinar & Avni Ilhan Bayhan

Authors
  1. Yakup Alpay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atakan Ezici
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammed Bilal Kurk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Osman Nuri Ozyalvac
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evren Akpinar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Avni Ilhan Bayhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yakup Alpay.

Ethics declarations

Conflict of interest

Yakup Alpay, Atakan Ezici, Bilal Kurk, Osman Nuri Ozyalvac, Evren Akpinar, Avni Ilhan Bayhan declare no conflict of interest.

Ethical approval

The study was approved by the Health Sciences University Baltalimani Bone and Joint Diseases Training and Research Hospital institutional review board (Approval ID number: 43-304).

Funding

None.

Informed consent

The need for informed consent was waived because of the study’s retrospective descriptive epidemiological design.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alpay, Y., Ezici, A., Kurk, M. et al. Increased femoral anteversion related to infratrochanteric femoral torsion is associated with ACL rupture. Knee Surg Sports Traumatol Arthrosc 28, 2567–2571 (2020). https://doi.org/10.1007/s00167-020-05874-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05874-0

Keywords

Search

Navigation