Evaluation of Femoral Anteversion in Cerebral Palsy

Objective: To investigate the femoral anteversion (FA) angle with clinical and radiological evaluations in patients with cerebral palsy (CP) and also to determine the relationship between radiologic imaging methods and clinical evaluation.Materials and Methods: For clinical evaluation of FA, Craig’s test, and for radiological evaluation of FA, direct radiography (the Rippstein-Müller method), computed tomography (CT) and magnetic resonance imaging (MRI) were used.Results: The mean age of the patients was 7.2±1.77 (5-11) years. The mean FA angles were 38.2°±8.4° (20°-50°) (Craig’s test), 56.5°±14.28° (25°-100°) (radiograph), 29.0°±10.5° (7°-49°) (CT) and 37.3°±10.6° (11°-68°) (MRI), respectively. The FA angle was significantly higher in patients with hip adductor muscle spasticity than in patients without adductor spasticity (p<0.05). The FA angles evaluated by Craig’s test and CT were correlated with hip internal rotation measurements and the FA angle with MRI was correlated with the difference between hip internal and external rotation measurements. When FA angle measurement methods were compared, Craig’s test positively correlated with CT and x-ray imaging and also, MRI positively correlated with direct radiography.Conclusion: The FA angle is high in children with CP. Hip adductor spasticity, increased hip internal rotation and the difference between hip internal and external rotation measurements on physical examination are cautionary signs for an increased FA angle. In this regard, Craig’s test appears to be a clinically relevant method for determining the FA angle. In addition, MRI may be preferred over CT in patients who have undergone femoral derotation osteotomy. Turk J Phys Med Rehab 2013;59:26-31.