Anterior knee pain and femoral torsion in female patients: Rationale and outcomes of rotational femoral osteotomy.

Femoral and/or tibial torsional abnormalities are highly prevalent in female patients with anterior knee pain (AKP) who are recalcitrant to appropriate conservative treatment. In this paper, we focus on increased internal femoral torsion, which sometimes is an under-recognised factor contributing to AKP. Two experts in patellofemoral pathology participated in conducting a review on the rationale and outcomes of rotational femoral osteotomy in female AKP patients and femoral maltorsion. Pathological femoral anteversion (FAV) is recognised as a cause of anterior knee pain. FAV is a problem because it changes the direction of the quadriceps and thereby the force acting on the patellofemoral joint. One of the key challenges in planning a rotational osteotomy is determining the precise degree of correction required. Murphy´s CT method is the closest to showing the anatomical reality when FAV is evaluated. Currently, there is no universally accepted cut-off point at which rotational femoral osteotomy should be performed. Moreover, limited evidence exists regarding the optimal level at which the osteotomy must be done. In appropriately selected cases, intertrochanteric rotational femoral osteotomy represents a reliable treatment option for symptomatic excessive FAV, offering favourable outcomes with minimal complications. Level of Evidence: Level V.