Femoral anteversion is an inward rotation of the femur bone from the upper neck part of the femur.
Page updated April 2024 by Dr Sheila Strover (Clinical Editor)
What is the cause of femoral anteversion?
Although a fracture may result in femoral anteversion, the condition is usually just something one is born with.
It is quite common in children, most of whom simply grow out of it, but if femoral anteversion persists into adolescence it may cause anterior knee pain and problems with gait.
Is femoral anteversion a disability?
Congenital femoral anteversion may be asymptomatic, but cause clumsiness of gait and sporting activities.
When severe it may lead to hip osteoarthritis, anterior knee pain and stress on the cruciate ligaments.
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Quote from peer-reviewed paper:
"....Increased femoral anteversion may occur with hip internal rotation and valgus knee alignment upon landing and is considered a risk factor for anterior cruciate ligament injury...."
Citation: Kaneko M, Sakuraba K. Association between Femoral Anteversion and Lower Extremity Posture upon Single-leg Landing: Implications for Anterior Cruciate Ligament Injury. J Phys Ther Sci. 2013 Oct;25(10):1213-7. doi: 10.1589/jpts.25.1213. Epub 2013 Nov 20. PMID: 24259760; PMCID: PMC3820182.
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Quote from peer-reviewed paper:
"....The only procedure that corrects abnormal version is a femoral derotational osteotomy. Presently, it is only performed for patients with abnormal version causing significant debilitation...."
Citation: Parker EA, Meyer AM, Nasir M, Willey MC, Brown TS, Westermann RW. Abnormal Femoral Anteversion Is Associated With the Development of Hip Osteoarthritis: A Systematic Review and Meta-Analysis. Arthrosc Sports Med Rehabil. 2021 Sep 2;3(6):e2047-e2058. doi: 10.1016/j.asmr.2021.07.029. PMID: 34977664; PMCID: PMC8689222.
Relationship of femoral anteversion to miserable malalignment
In the condition referred to as miserable malalignment, there are rotational deformities of both the femur and the tibia.
Although at rest the knee may point forwards, in fact this is because the femur is rotating inwards while the tibia is rotating outwards.
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Quote from peer-reviewed paper:
"....in children, adolescents, and young adult patients, the recognition of lower limb torsional malalignment is often overlooked...."
Citation: Elsheikh AA, Cross GWV, Wright J, Goodier WD, Calder P. Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator. J Orthop Surg Res. 2023 Oct 11;18(1):768. doi: 10.1186/s13018-023-04252-z. PMID: 37817247; PMCID: PMC10566009.
Forum discussions
- "Considering a derotational tibial osteotomy"
Patients discussing tibial de-rotation, but also femoral de-rotation.
See also -
From the Experts -
- Expert view - 2014 - Rotational Deformity ("Miserable Malalignment") - by Dr Mark Sanders (Knee Surgeon)