Determining the Origin of Deformity in Torsional Femoral Pathology: A Narrative Review and an Illustrative Pilot Study of a Novel Methodology
Chiappe, Caterina (Universitat Autónoma de Barcelona)
Roselló Añón, Alejandro (Hospital Arnau de Vilanova (València))
Más-Estellés, Jorge (Universitat Politècnica de València)
Gil-Santos, Luis (Hospital Arnau de Vilanova (València))
Monllau, Joan Carles (Hospital Arnau de Vilanova (València))
Sanchis-Alfonso, Vicente (Hospital Arnau de Vilanova (València))

Data:	2025
Resum:	Background: The Derotational femoral osteotomy (DFO) is an effective surgical treatment for patients with disabling anterior knee pain associated with pathological Femoral anteversion (FAV). However, the complexity in determining the precise origin of the deformity has put limits on its use. This study aims to review the literature to learn how the authors study the origin of the deformity and then provide a new methodology using 3D technology to assess the origin of FAV. Methods: A search of the literature was conducted on PubMed utilizing the following search string: "anteversion" and "femur" or "origin" or "CT" or "MRI" or "3D". In addition, an observational study was conducted on CT scans of six femurs from three female patients with unilateral pathological FAV. This work represents a pilot study and should be considered preliminary. Using the 3DSlicer (version 4. 11. 20210226), MeshMixer (version3. 5), and 3DBuilder software (Microsoft. com), 3D biomodels were generated. A mirrored healthy femur served as a reference. The CloudCompare software (software version 2. 13. 0) was used to compare volumetric structures and analyze torsional deformities. Torsion at each level was quantified using MATLAB (software version 23. 2). Results: The 3D technology identified three torsional patterns: 1. FAV predominantly originating at the femoral head (distance between the centroids = maximum deformity in the last discs, which coincides with the proximal region of the femur; heat maps = red in the proximal femur); 2. FAV primarily affects the mid-distal diaphysis (distance between the centroids = maximum deformity in the first discs, which coincides with mid-distal third of the femur; heat maps = red in the diaphyseal level); 3. a pan-diaphyseal deformity involving the entire femur (distance between the centroids = both the first and last discs, means deformity along the entire femur; heat maps = red along the entire femoral diaphysis). Conclusions: All femoral segments contributed to the total FAV, but the location and severity varied among the cases. Pathological FAV is a multifactorial deformity that can arise in different femoral regions. Individualized correction strategies are essential to improving DFO outcomes and preventing secondary deformities. It is important to note that the pilot data is intended to be purely illustrative and, as such, should not be utilized for the purposes of guiding clinical decision-making.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Femoral anteversion ; Anterior knee pain ; Derotational osteotomy ; CT scan ; MRI ; 3D technology
Publicat a:	Journal of clinical medicine, Vol. 14 Núm. 18 (September 2025) , ISSN 2077-0383

DOI: 10.3390/jcm14186489
PMID: 41010695

19 p, 3.8 MB

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