Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation

Introduction/objectives: To investigate the effect of femoral maltorsion on both the patellofemoral and the tibiofemoral contact pressures. Methods: Experimental biomechanical study on 10 embalmed human cadaveric knees (mean age 40.2 years ​± ​9.5). Krackow sutures were placed in the vastus medialis...

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Authors: Morales Avalos, Rodolfo, Chiappe, Caterina, Ceniceros-Cantú, Christopher, Cienfuegos-Jiménez, Gerardo, Garza-López, Judith, Ortiz-García, Carlos F., Elizondo Omaña, Rodrigo E., Guzmán-López, Santos, Monllau García, Juan Carlos, Sanchis-Alfonso, Vicente
Format: article
Status:Published version
Publication Date:2025
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:dnet:recercat____::6af1fe23bad05922eea4b1de297f9dcb
Online Access:https://hdl.handle.net/10230/73472
http://dx.doi.org/10.1016/j.jisako.2025.100866
Access Level:Open access
Keyword:Anteversion
Biomechanics
Femoral maltorsion
Femoral osteotomy
Knee osteoarthritis
Malalignment
Patellofemoral pressures
Tibiofemoral pressures
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spelling Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluationMorales Avalos, RodolfoChiappe, CaterinaCeniceros-Cantú, ChristopherCienfuegos-Jiménez, GerardoGarza-López, JudithOrtiz-García, Carlos F.Elizondo Omaña, Rodrigo E.Guzmán-López, SantosMonllau García, Juan CarlosSanchis-Alfonso, VicenteAnteversionBiomechanicsFemoral maltorsionFemoral osteotomyKnee osteoarthritisMalalignmentPatellofemoral pressuresTibiofemoral pressuresIntroduction/objectives: To investigate the effect of femoral maltorsion on both the patellofemoral and the tibiofemoral contact pressures. Methods: Experimental biomechanical study on 10 embalmed human cadaveric knees (mean age 40.2 years ​± ​9.5). Krackow sutures were placed in the vastus medialis, vastus lateralis, rectus femoris, vastus intermedius, and hamstrings. A custom-made test apparatus capable of independently loading the quadriceps and hamstring muscle groups and providing ground reaction forces during a simulated squat maneuver and under direct axial compression loading was used. A ground reaction force of 1000 ​N was applied to the distal tibia and scaled loads of 218N and 80N were applied to the quadriceps and hamstrings, respectively, at 0°, 30°, 60°, and 90° of flexion. Pressure measurements were performed by intra-articularly placed sensors (77.3 ​× ​77.3 ​mm, SFM6000CXR2 Sensor) and using Snowforce 3 interpretation software. After testing of the native knee, supracondylar femoral osteotomy was performed. Pressure measurements were again made in each knee compartment, at each of the degrees of rotation evaluated. Results: Medial aspect of the patella showed an increase of contact pressure with external femoral rotation from 10° to 30° compared with 0°. The strongest effect was measured at 30° of knee flexion (p ​= ​0.005) with 30° of external rotation (p ​= ​0.004) with a value of 2.140 ​± ​0.1832 Mpa. With internal femoral rotation there is an increment of contact pressure in the lateral aspect of the patella, with the strongest effect at 30° of flexion (p ​= ​0.0059) with 30° of internal rotation (p ​= ​0.0002) with a value of 1.352 ​± ​0.08166 Mpa. The medial tibiofemoral contact pressure showed an increment from 10° to 30° of external rotation compared with the native state. The highest pressure was shown at 90° of knee flexion (p ​= ​0.0006) and 30° of external rotation (p ​= ​0.004) with a value of 1.636 ​± ​0.01878 Mpa. The lateral tibiofemoral contact pressure increased compared with the control group more with internal than with external rotation. The highest pressure was shown at 90° of flexion (p ​< ​0.0001) and 30° of internal rotation (p ​< ​0.0001) with a value of 1.432 ​± ​0.004051 Mpa. Conclusions: Femoral malrotation influences patellofemoral and tibiofemoral contact pressure. Femoral external rotation may result in worse knee biomechanics than internal rotation. Level of evidence: III.Elsevier2026202620252026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/10230/73472http://dx.doi.org/10.1016/j.jisako.2025.100866https://hdl.handle.net/10230/73472reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésJournal of ISAKOS. 2025;12:100866© 2025 The Author(s). Published by Elsevier Inc. on behalf of International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:dnet:recercat____::6af1fe23bad05922eea4b1de297f9dcb2026-05-29T05:05:01Z
dc.title.none.fl_str_mv Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
title Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
spellingShingle Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
Morales Avalos, Rodolfo
Anteversion
Biomechanics
Femoral maltorsion
Femoral osteotomy
Knee osteoarthritis
Malalignment
Patellofemoral pressures
Tibiofemoral pressures
title_short Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
title_full Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
title_fullStr Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
title_full_unstemmed Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
title_sort Femoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation
dc.creator.none.fl_str_mv Morales Avalos, Rodolfo
Chiappe, Caterina
Ceniceros-Cantú, Christopher
Cienfuegos-Jiménez, Gerardo
Garza-López, Judith
Ortiz-García, Carlos F.
Elizondo Omaña, Rodrigo E.
Guzmán-López, Santos
Monllau García, Juan Carlos
Sanchis-Alfonso, Vicente
author Morales Avalos, Rodolfo
author_facet Morales Avalos, Rodolfo
Chiappe, Caterina
Ceniceros-Cantú, Christopher
Cienfuegos-Jiménez, Gerardo
Garza-López, Judith
Ortiz-García, Carlos F.
Elizondo Omaña, Rodrigo E.
Guzmán-López, Santos
Monllau García, Juan Carlos
Sanchis-Alfonso, Vicente
author_role author
author2 Chiappe, Caterina
Ceniceros-Cantú, Christopher
Cienfuegos-Jiménez, Gerardo
Garza-López, Judith
Ortiz-García, Carlos F.
Elizondo Omaña, Rodrigo E.
Guzmán-López, Santos
Monllau García, Juan Carlos
Sanchis-Alfonso, Vicente
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Anteversion
Biomechanics
Femoral maltorsion
Femoral osteotomy
Knee osteoarthritis
Malalignment
Patellofemoral pressures
Tibiofemoral pressures
topic Anteversion
Biomechanics
Femoral maltorsion
Femoral osteotomy
Knee osteoarthritis
Malalignment
Patellofemoral pressures
Tibiofemoral pressures
description Introduction/objectives: To investigate the effect of femoral maltorsion on both the patellofemoral and the tibiofemoral contact pressures. Methods: Experimental biomechanical study on 10 embalmed human cadaveric knees (mean age 40.2 years ​± ​9.5). Krackow sutures were placed in the vastus medialis, vastus lateralis, rectus femoris, vastus intermedius, and hamstrings. A custom-made test apparatus capable of independently loading the quadriceps and hamstring muscle groups and providing ground reaction forces during a simulated squat maneuver and under direct axial compression loading was used. A ground reaction force of 1000 ​N was applied to the distal tibia and scaled loads of 218N and 80N were applied to the quadriceps and hamstrings, respectively, at 0°, 30°, 60°, and 90° of flexion. Pressure measurements were performed by intra-articularly placed sensors (77.3 ​× ​77.3 ​mm, SFM6000CXR2 Sensor) and using Snowforce 3 interpretation software. After testing of the native knee, supracondylar femoral osteotomy was performed. Pressure measurements were again made in each knee compartment, at each of the degrees of rotation evaluated. Results: Medial aspect of the patella showed an increase of contact pressure with external femoral rotation from 10° to 30° compared with 0°. The strongest effect was measured at 30° of knee flexion (p ​= ​0.005) with 30° of external rotation (p ​= ​0.004) with a value of 2.140 ​± ​0.1832 Mpa. With internal femoral rotation there is an increment of contact pressure in the lateral aspect of the patella, with the strongest effect at 30° of flexion (p ​= ​0.0059) with 30° of internal rotation (p ​= ​0.0002) with a value of 1.352 ​± ​0.08166 Mpa. The medial tibiofemoral contact pressure showed an increment from 10° to 30° of external rotation compared with the native state. The highest pressure was shown at 90° of knee flexion (p ​= ​0.0006) and 30° of external rotation (p ​= ​0.004) with a value of 1.636 ​± ​0.01878 Mpa. The lateral tibiofemoral contact pressure increased compared with the control group more with internal than with external rotation. The highest pressure was shown at 90° of flexion (p ​< ​0.0001) and 30° of internal rotation (p ​< ​0.0001) with a value of 1.432 ​± ​0.004051 Mpa. Conclusions: Femoral malrotation influences patellofemoral and tibiofemoral contact pressure. Femoral external rotation may result in worse knee biomechanics than internal rotation. Level of evidence: III.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/10230/73472
http://dx.doi.org/10.1016/j.jisako.2025.100866
https://hdl.handle.net/10230/73472
url https://hdl.handle.net/10230/73472
http://dx.doi.org/10.1016/j.jisako.2025.100866
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Journal of ISAKOS. 2025;12:100866
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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