Femoral Anteversion

Femoral Anteversion: Forward (anterior) rotation of the femoral neck relative to the femoral condyles (the distal end of the femur) in the transverse plane. This could be viewed as the amount of rotation or twist in the femur between the knee and femoral neck.

Specifically, it is the degrees of rotation between the epicondyles at the distal end of the femur, which articulates with the tibial plateau at the knee joint, and the femoral neck at the proximal end of the femur, which articulates with the acetabulum (hip socket) of the pelvis and hip joint.

For additional information:

• Article: Hip Anatomy and Squat Form
• Course: Lower Body Exercise Progressions
• Course: Hip Joint Anatomy (Pelvifemoral Joint)

Evidence-Based Summary Statement from the comprehensive systematic research review of Hip Version Angle (included in the course and article linked above):

• The average adult version angle is anteriorly rotated 7° - 19°, with a standard deviation (SD) ± 9.66°, a range of -4° - 36°, and is normally distributed. Note that individual research studies generally report similar SD and ranges, which likely implies there are some differences in measurement methodology from study to study. This may have resulted in a relatively wide range of averages. Toogood et al. (2009) demonstrated that as the neck version angle or inclination angle increased, translation in the same direction at the head-neck junction tended to decrease, demonstrating some compensatory adaptation. Further, some, but not all, dysfunctions may be correlated with a higher prevalence of extreme version angles. Last, research has demonstrated that knee pain is correlated with significantly less hip and knee internal rotation and more knee varus, tibia external rotation, and foot external rotation during a variety of activities. This implies that the recommendation to turn the feet out and/or "drive" the knees into varus (knees bow out) may contribute to an increased risk of pain and dysfunction.

Additional Considerations

Opposite: Retroversion

Clinical Implications: Excessive anteversion can contribute to various orthopedic and functional issues, such as altered hip joint mechanics (e.g., a predisposition to hip dysplasia), an increased risk of orthopedic pain (e.g., patellofemoral pain syndrome), or in relatively extreme cases, toeing-in (a.k.a. pigeon-toed) gait.

Assessment: While imaging has exhibited accuracy and reliability, the clinical test known as the "Craig's Test" likely lacks sufficient accuracy to be useful (1-3).

1. Choi, B. R., & Kang, S. Y. (2015). Intra-and inter-examiner reliability of goniometer and inclinometer use in Craig’s test. Journal of physical therapy science, 27(4), 1141-1144.
2. Ito, I., Miura, K., Kimura, Y., Sasaki, E., Tsuda, E., & Ishibashi, Y. (2020). Differences between the Craig’s test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries. Journal of physical therapy science, 32(6), 365.
3. Souza, R. B., & Powers, C. M. (2009). Concurrent criterion-related validity and reliability of a clinical test to measure femoral anteversion. journal of orthopaedic & sports physical therapy, 39(8), 586-592.