Femoral inherent torsion is more accurate than femoral anteversion angle in evaluating femoral torsion to determine whether combine derotational distal femoral osteotomy or not.

Abstract

Background: Previous view is that femoral anteversion angle (FAA) is equivalent to femoral torsion (FT) and as an indication for derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament reconstruction (MPFLR), but posterior femoral condylar deformity affects FAA. Therefore, FAA is not accurate in assessing FT. Whether the femoral inherent torsion (FIT), which avoids the influence of the posterior condyle, can better reflect FT during surgery remains unknown. Meanwhile, the impact of the posterior femoral condyle on surgical outcomes remains unclear.

Methods: Twenty-five patellar dislocation (PD) patients from 2017 to 2021 were conducted. All patients underwent both preoperative and postoperative computed tomography scans. Categorized by posterior condylar angle (PCA), they were divided into Group A (PCA ≤ 6.4°) and Group B (PCA > 6.4°). Radiographic measurements included FAA, femoral inherent torsion (FIT), patellar tilt angle, congruence angle and tibial tubercle-trochlear groove distance. For clinical outcomes, the Kujula score, Lysholm score, IKDC score to reflect the knee function. The Tegner activity score was used to assess the activity level. The VAS score was used to assess the pain control.

Results: In both groups, the postoperative radiographic outcomes demonstrated a statistically significant improvement. Preoperatively, the FAA was similar in the two groups, but the FIT was greater in the Group A (21.7° ± 1.2° vs 18.4° ± 1 .3°, P < 0.001). However, there was no statistically significant difference between them in the postoperative period (7.4° ± 1.5° vs 7.1° ± 1.8°). In terms of clinical outcomes, both groups demonstrated a significant improvement in the postoperative period. However, the scores of the Group A significantly better (Kujula: 85.7 ± 5.0 vs 79.6 ± 4.8, P = 0.005; Lysholm: 86.8 ± 5.3 vs 80.2 ± 5.7, P = 0.006; IKDC: 86.1 ± 8.8 vs 75.5 ± 7.6, P = 0.004).

Conclusion: FIT may be a more reliable indicator than FAA for evaluating FT in PD to determine whether combine DDFO or not, especially in the presence of posterior femoral condylar deformity. Posterior femoral condylar deformity appeared to result in a pseudo-increase in FAA. Simultaneous evaluation of FIT and FAA to identify true posterior condylar deformity offers the potential to prevent enlargement of DDFO and enable precision treatment.