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Femoral anteversion measured by the surgical transepicondylar axis is a reliable parameter for evaluating femoral rotational deformities in patients with patellar dislocation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To verify whether femoral anteversion measured by the surgical transepicondylar axis (S-FA) is a reliable parameter for evaluating femoral rotational deformities and to provide an indication for derotational distal femoral osteotomy (DDFO) in patients with patellar dislocation.

Methods

Ninety patients with recurrent patellar dislocation and 90 healthy individuals were enrolled. The S-FA, the femoral anteversion measured by posterior condylar reference line (P-FA), the length of posterior femoral condyles, and the posterior condylar angle (PCA) were assessed by CT images. The unpaired t test and Pearson correlation analysis were conducted. Receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate the diagnostic capacity of the parameters. The pathological value of the measurements was determined, and a binary regression model was established.

Results

The S-FA and P-FA were greater in the study group (14.2 ± 7.7° and 19.7 ± 7.3°, respectively) than in the control group (7.2 ± 8.0° and 12.2 ± 8.2°, respectively) (P < 0.001). The lateral/posterior condyle was shorter in patients with patellar dislocation (21.2 ± 2.5 mm) than in healthy individuals (23.5 ± 2.7 mm) (P = 0.001). The P-FA was correlated with PCA in the study group (P < 0.001). The S-FA and P-FA had AUCs of 0.734 and 0.767 for patellar dislocation, respectively. The pathological values of the S-FA and P-FA were 20.4° and 25.8°, respectively. The S-FA revealed a significant OR of 10.47 (P = 0.014) for patellar dislocation.

Conclusion

The S-FA is a reliable parameter for identifying femoral rotational deformities in patients with patellar dislocation. DDFO is recommended when a pathological S-FA (> 20.4°) is presented.

Level of evidence

Retrospective cohort study (diagnostic), level II.

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Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

Code availability

Not applicable.

Abbreviations

DDFO:

Derotational distal femoral osteotomy

FA:

Femoral anteversion

LPD:

The distance between the SEA and the posterior margin of the lateral femoral condyle

MPD:

The distance between the SEA and the posterior margin of the medial femoral condyle

PCA:

Posterior condylar angle, the angle between SEA and PCRL

PCRL:

Posterior condylar reference line

PD:

Patellar dislocation

PFA:

Proximal femoral axis, the line through the center of the femoral head and neck

P-FA:

The femoral anteversion measured by PCRL, the angle between the PCRL and PFA

PFCD:

Posterior femoral condyle dysplasia

SEA:

Surgical epicondylar axis

S-FA:

The femoral anteversion measured by SEA, the angle between the SEA and PFA

TEW:

Transepicondylar width

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Acknowledgements

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Baoshan Yin, Jinjiang Yao, Yunlong Zhou, Hua Zhang, Jian Zhang & Aiguo Zhou

  2. Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Baoshan Yin, Jinjiang Yao, Yunlong Zhou, Hua Zhang, Jian Zhang & Aiguo Zhou

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  1. Jiaxing Chen
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  2. Baoshan Yin
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  3. Jinjiang Yao
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  4. Yunlong Zhou
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  5. Hua Zhang
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  6. Jian Zhang
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  7. Aiguo Zhou
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection was performed by Hua Zhang, Jinjiang Yao and Yunlong Zhou. Statistical analysis was conducted by Jiaxing Chen. The first draft of the manuscript was written by Jiaxing Chen, and modified by Baoshan Yin. Jian Zhang and Aiguo Zhou provided theoretical supports and revised the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Aiguo Zhou.

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Conflicts of interest

The authors declare they have no financial interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. (Number: 2022-K8).

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The informed consent was waived by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.

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Chen, J., Yin, B., Yao, J. et al. Femoral anteversion measured by the surgical transepicondylar axis is a reliable parameter for evaluating femoral rotational deformities in patients with patellar dislocation. Knee Surg Sports Traumatol Arthrosc 31, 3061–3069 (2023). https://doi.org/10.1007/s00167-022-07016-0

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  • DOI: https://doi.org/10.1007/s00167-022-07016-0

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