ArticleJournal of experimental orthopaedics2022
Examining the effects of femoral anteversion and passive hip rotation on ACL injury and knee biomechanics: a systematic review and meta-analysis.
Article in Journal of experimental orthopaedics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 8 citations in OpenAlex.
- Bridging postural biomechanics and knee arthroplasty success.Arthroplasty (London, England) · 2026Review
- Age is not a primary risk factor for anterior cruciate ligament injury-A comprehensive review of anterior cruciate ligament injury and reinjury risk factors confounded by young patient age.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Review
- Comparative biomechanical analysis of volleyball court shoes during sport-specific tasks in competitive adolescent female volleyball players.Frontiers in sports and active living · 2026Article
- Knee laxity, joint hypermobility, femoral anteversion, hamstring extensibility and navicular drop as risk factors for non-contact anterior cruciate ligament injury in female athletes: A 4.5-year prospective cohort study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Femoral anteversion as a potential risk factor for anterior cruciate ligament injuries in athletes.Journal of experimental orthopaedics · 2025Article
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeGreater femoral internal rotation (via anteversion or passive hip ROM) is associated with knee biomechanics thought to contribute to anterior cruciate ligament (ACL) injury, but it is unknown if femoral internal rotation contributes to actual ACL injury occurrence. The objective of this systematic review and meta-analysis was to quantify the extent to which femoral anteversion and hip range of motion (ROM) influence knee biomechanics consistent with ACL injury and actual ACL injury occurrence.
methodsUsing PRISMA guidelines, PubMed, CINAHL, SportDiscus, and Scopus databases were searched. Inclusion criteria were available passive hip ROM or femoral anteversion measure, ACL injury OR biomechanical analysis of functional task. Two reviewers independently reviewed titles, abstracts, and full texts when warranted. Included studies were submitted to Downs & Black Quality Assessment Tool. Meta-analyses were conducted for comparisons including at least two studies.
resultsTwenty-three studies were included (11 injury outcome, 12 biomechanical outcome). Decreased internal rotation ROM was significantly associated with history of ACL injury (MD -5.02°; 95% CI [-8.77°--1.27°]; p = 0.01; n = 10). There was no significant effect between passive external rotation and ACL injury (MD -2.62°; 95% CI [-5.66°-- 0.41°]; p = 0.09; n = 9) Participants displaying greater frontal plane knee projection angle had greater passive external rotation (MD 4.77°; 95% CI [1.17° - 8.37°]; p = 0.01; n = 3). There was no significant effect between femoral anteversion and ACL injury (MD -0.46°; 95% CI [-2.23°-1.31°]; p = 0.61; n = 2). No within-sex differences were observed between injured and uninjured males and females (p range = 0.09 - 0.63).
conclusionThough individuals with injured ACLs have statistically less passive internal and external rotation, the observed heterogeneity precludes generalizability. There is no evidence that femoral anteversion influences biomechanics or ACL injury. Well-designed studies using reliable methods are needed to investigate biomechanical patterns associated with more extreme ROM values within each sex, and their prospective associations with ACL injury. LEVEL OF EVIDENCE: IV.
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