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Open AccessArticle

Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory

1
Department of Orthopaedic Surgery, Hospital Universitarioy Politécnico La Fe, 46026 Valencia, Spain
2
Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, 46015 Valencia, Spain
3
Department of Radiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(12), 3835; https://doi.org/10.3390/jcm9123835
Received: 14 October 2020 / Revised: 19 November 2020 / Accepted: 24 November 2020 / Published: 26 November 2020
(This article belongs to the Special Issue The Role of Skeletal Malalignment In Patellofemoral Disorders)
Background: The origin of femoral maltorsion is often unknown. However, defining the origin of the rotation of the femoral maltorsion can be useful for establishing the most suitable point to do an external derotational osteotomy. Previous studies have not considered the femoral diaphysis in their investigations of the origin of the deformity. The study of the whole morphology of the femur with 3D volumetric tools, including the femoral diaphysis can contribute to a better understanding of the behavior of femoral maltorsion. Methods: An atypical case of unilateral femoral anteversion was selected. Both femurs were used to obtain 3D bio-models. The mirror image of the asymptomatic side was obtained and overlapped with the symptomatic femur. The Hausdorff–Besicovitch method was used to evaluate the morphologic discrepancies (in mm) between the two femurs in three zones: (1) the femoral neck, (2) the proximal diaphysis, and (3) the distal diaphysis. The differences between the two femurs were analyzed and its correlation was statistically defined using a lineal regression model. Results: The deformity in the distal diaphysis increased from the supracondylar area until the apex of the antecurvatum angle (R2 = 0.91) and then decreased until the base of the femoral neck (R2 = (−0.83)), to finally increase significantly in the femoral neck area (R2 = 0.87). All of the correlations were statistically significant (p-value ˂ 0.001). Conclusion: The femoral maltorsion originates in the supracondylar area and its rotational axis is the longitudinal axis of the femoral diaphysis. Even though the deformity affects the femoral diaphysis, its clinical relevance is much higher in the femoral neck since the rotational axis passes through its base. Thus, the osteotomy can be conducted along all of the femoral diaphysis as long as it is done perpendicular to it. View Full-Text
Keywords: femoral anteversion origin; femoral osteotomy; anterior knee pain femoral anteversion origin; femoral osteotomy; anterior knee pain
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MDPI and ACS Style

Ferràs-Tarragó, J.; Sanchis-Alfonso, V.; Ramírez-Fuentes, C.; Roselló-Añón, A.; Baixauli-García, F. Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory. J. Clin. Med. 2020, 9, 3835. https://doi.org/10.3390/jcm9123835

AMA Style

Ferràs-Tarragó J, Sanchis-Alfonso V, Ramírez-Fuentes C, Roselló-Añón A, Baixauli-García F. Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory. Journal of Clinical Medicine. 2020; 9(12):3835. https://doi.org/10.3390/jcm9123835

Chicago/Turabian Style

Ferràs-Tarragó, Joan; Sanchis-Alfonso, Vicente; Ramírez-Fuentes, Cristina; Roselló-Añón, Alejandro; Baixauli-García, Francisco. 2020. "Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory" J. Clin. Med. 9, no. 12: 3835. https://doi.org/10.3390/jcm9123835

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