UNASSIGNED: Surgery is the main treatment for recurrent patellar dislocation (PD). However, due to the complexity of anatomical factors, there is still a lack of consensus on the choice of combined surgical methods. This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction combined with derotational distal femur osteotomies (MPFLR + DDFO) and combined with tibial tubercle osteotomies (MPFLR + TTO) for recurrent PD with increased femoral anteversion angles (FAA) and excessive tibial tubercle-trochlear groove (TT-TG) distance.
UNASSIGNED: In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes.
UNASSIGNED: All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2).
UNASSIGNED: Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.

UNASSIGNED: Children with spastic cerebral palsy (CP) often show an increase in femoral anteversion angle (FAA). Computed tomography (CT) scan is the main modality for evaluating FAA in these patients, however, due to significant radiation exposure, it carries a high carcinogenic risk. FEMORA® software is expected to be able to accurately assess FAA even with conventional X-ray images that only require low radiation exposure. However, its validity has not been tested in various populations or CT devices. This study aimed to validate the FEMORA® software by comparing it to CT scans done on an Indonesian population.
UNASSIGNED: All spastic CP patients of the outpatient clinic at Dr. Soetomo Hospital between March and November 2022, were included. The FEMORA® Software evaluation was performed by three examiners. The calculation results were averaged and compared with those of the CT scan. Intraclass correlation coefficient (ICC), reliability, and correlation were be assessed.
UNASSIGNED: There were 36 patients included in this study. Most were female (n = 22; 61,1 %) and the average age was 7,28 years old. Interobserver preoperative analysis using ICC showed good outcomes (p = 0.918; 95 % CI, 0.858-0.955). FAA measurement results using FEMORA® and CT scans were 41,71 ± 12,90 and 32,68 ± 11,85, respectively. Correlation coefficient between the two values is 0.634 (p < 0.001).
UNASSIGNED: FEMORA® software demonstrates a good and significant correlation with FAA measurement using CT scan.

BACKGROUND: The femoral anteversion angle is an important factor in performing surgery in the proximal part of the femur. Predicting the femoral anteversion angle based on the morphology of the proximal femur is clinically useful. The purpose of this study was to investigate whether an anatomical landmark can be used to predict the femoral anteversion angle intraoperatively.
METHODS: We analysed CT data obtained from 100 hips in 69 patients with osteonecrosis of the femoral head with no more than 2 mm collapse and no evidence of osteoarthritic changes. The measured variables were the femoral anteversion angle, the femoral neck-shaft angle, and the AW angle (defined as the angle between the femoral shaft axis and the tangential line of the anterior wall of the greater trochanter). The correlations between variables were also investigated. Multiple regression analysis by the forced input method was performed for the degree of femoral anteversion angle, using sex and the AW angle as explanatory variables.
RESULTS: On CT, the mean femoral anteversion angle was 14.8° ± 10.8°, the mean AW angle was 17.5° ± 8.0°, and the mean femoral neck-shaft angle was 127.3° ± 5.4°. There was a positive correlation between the femoral anteversion angle and the AW angle. The approximation equations based on the multiple regression analysis were as follows: male femoral anteversion angle = AW angle × 0.7 - 0.7 and female femoral anteversion angle = AW angle × 0.7 + 4.3.
CONCLUSIONS: Femoral anteversion angle can be predicted based on the AW angle of the greater trochanter.

UNASSIGNED: One of the common causes of gait disturbance in children is increased femoral anteversion. There are not enough publications in the literature on muscles related to the hip joint in increased femoral anteversion. The aim of this study was to evaluate the relationship between the femoral anteversion angle and hip muscle elasticity in children walking inward, using shear wave elastography (SWE).
UNASSIGNED: Seventeen children with bilateral increased femoral anteversion angle in computed tomography were prospectively included in this study. Elasticity values of the hip muscles (adductor magnus (adductor), iliopsoas (flexor), gluteus medius (abductor), gluteus maximus (extensor) muscles) were evaluated by ultrasound elastography by two observers. Quantitative measurements of the shear wave velocities were performed using virtual touch tissue imaging quantification.
UNASSIGNED: There was excellent harmony between the femoral anteversion angle measurements performed by the two observers and a good congruence between the muscle elastography evaluations. While there was a moderate significant correlation between the femoral anteversion angle and the elasticity values of the iliopsoas and adductor magnus muscles, no significant correlation was found with other muscle elasticity measurements.
UNASSIGNED: Iliopsoas muscle and adductor magnus muscle elasticity are correlated with the femoral anteversion angle. With further studies, we think that physical therapy methods for the elasticity of the muscles associated with the femoral anteversion angle can reduce the complaints of the patients.

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum.
METHODS: Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15-29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis.
RESULTS: A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24-33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05).
CONCLUSIONS: MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

To promote the development of an optimally functional total hip prosthesis for medium and large dog breeds, accurate measurements of the normal anatomy of the proximal femur and acetabular retroversion are essential. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of both medium and large breeds. Based on the length of their femora 58 dogs were allocated either to group I: ≤195 mm or group II: >195 mm. In the study the femoral anteversion angle (FAA) was measured on each femur using multi-slice spiral computed tomography (CT). The data were processed as multi-planar and three-dimensional reconstructions using Advantage Workstation software. The CT measurements showed that the mean ± standard deviation (SD) FAA of group I was 31.34 ± 5.47° and in group II it was 31.02 ± 4.95°. There were no significant mean difference associations between the length of the femur and the femoral neck angle in either group (P > 0.05). The data suggest that a prosthesis FAA of 31 degrees would be suitable for a wide range of dog sizes.

[Purpose] This study aimed to compare the Craig\'s test and computed tomography (CT) in measuring the femoral anteversion angle (FAA) in patients with anterior cruciate ligament (ACL) injuries. The relationship between the FAA measured on CT, and the range of axial rotation of the hip joint and muscle tightness around the hip joint was also investigated. [Participants and Methods] Twenty-six patients who received CT examination within 3 months after ACL reconstruction were enrolled in this study. The Craig\'s test, internal and external rotation of the hip, the Ely test, Ober\'s test, and FAA on the CT were assessed. [Results] The FAA on the Craig\'s test and CT in female patients was 24.3 ± 3.9° and 23.0 ± 10.3°, respectively on the uninjured side and 25.0 ± 5.2° and 20.3 ± 11.2°, respectively on the injured side, indicating no significant correlation between the 2 measurement techniques. In contrast, the FAA on the CT was significantly correlated with the range of internal rotation of the hip, which was 40.5 ± 6.1° on the uninjured side and 37.8 ± 5.6° on the injured side. [Conclusion] The results suggest that measuring the internal hip rotation range rather than the Craig\'s test, provides more reliable estimates of the magnitude of FAA, and may help to evaluate the risk of ACL injuries in female athletes.