Femoral malrotation and patellofemoral osteoarthritis: cadaveric study

Abstract

BACKGROUND: Femoral rotational alignment has been proposed as one factor that may influence patellar tracking and the distribution of patellofemoral joint loading. The present study explored whether characteristic patterns of patellar facet degeneration coexist with abnormally high or low femoral version angles. METHODS: An observational study was conducted on 15 cadaveric specimens. Femoral version was measured, and patellofemoral articular degeneration was assessed. The association between femoral version category and the distribution of patellofemoral osteoarthritis was examined. RESULTS: The relationship between femoral version category (low, normal, high) and patellofemoral osteoarthritis distribution (medial, lateral, both facets) was evaluated using the Fisher-Freeman-Halton exact test. A statistically significant association was identified (p = 0.0017). Low femoral version was more frequently accompanied by medial-facet osteoarthritis, whereas high femoral version was more often accompanied by lateral-facet involvement. Normal femoral version showed no consistent pattern. No significant gender or side differences were observed. CONCLUSIONS: Different femoral version categories were accompanied by different patterns of patellofemoral osteoarthritis in this cadaveric sample. These findings represent anatomical associations rather than mechanistic relationships. Further studies incorporating age data, clinical populations, and biomechanical assessment are needed to clarify the relevance of femoral rotational alignment in patellofemoral disorders.