{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:34:50Z","timestamp":1790004890662,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D\u2010CT\u2010scan\u2010based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter\u2010 and intra\u2010individual variations of torsional deformity of healthy individuals\u2019 lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side\u2010to\u2010side asymmetry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT\u2010scan\u2010based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.05 was considered as statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, the mean FNV was 15.3\u2009\u00b1\u20099.5\u00b0 and the mean TT was 31.6\u2009\u00b1\u20096.3\u00b0. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side\u2010to\u2010side asymmetry was found for FNV [absolute difference (AD)\u2009=\u20096.3\u00b0; percentage of asymmetry (%As)\u2009=\u200947%], TT1 (AD\u2009=\u20093\u00b0; %As\u2009=\u200912%), and TT2 (AD\u2009=\u20094.9\u00b0; %As\u2009=\u20099%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06096-0","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T03:02:35Z","timestamp":1592276555000},"page":"1083-1089","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Healthy middle\u2010aged Asian and Caucasian populations present with large intra\u2010 and inter\u2010individual variations of lower limb torsion"],"prefix":"10.1002","volume":"29","author":[{"given":"P.","family":"Mathon","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte\u2010Marguerite Hospital Aix Marseille University, APHM, CNRS, ISM 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Micicoi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte\u2010Marguerite Hospital Aix Marseille University, APHM, CNRS, ISM 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille France"},{"name":"<!--<label>3<\/label>--> iULS\u2010University Institute for Locomotion and Sports, Pasteur 2 Hospital University C\u00f4te D\u2019Azur Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Seil","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Centre Hospitalier Universitaire du Luxembourg Luxembourg Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Kacaoglu","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopedic Surgery, Acibadem Altunizade Hospital Acibadem University, Faculty of Medicine Tophanelioglu Cad. No: 1, Altunizade Istanbul Uskudar Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Cerciello","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Marrelli Hospital Crotone Italy"},{"name":"<!--<label>6<\/label>--> Casa Di Cura Villa Betania Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"<!--<label>7<\/label>--> Stryker Mawhaw NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"LiArno","sequence":"additional","affiliation":[{"name":"<!--<label>7<\/label>--> Stryker Mawhaw NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Teitge","sequence":"additional","affiliation":[{"name":"<!--<label>8<\/label>--> Detroit Medical Center 3990 John R St. 48201 Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte\u2010Marguerite Hospital Aix Marseille University, APHM, CNRS, ISM 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,16]]},"reference":[{"key":"e_1_2_9_2_2","first-page":"288","article-title":"Innovations in hip arthroplasty three\u2010dimensional modeling and analytical technology (SOMA)","volume":"24","author":"Banerjee S","year":"2014","journal-title":"Surg Technol Int"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102004\u2010813366"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.05.036"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.90B8.19905"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010009\u20100870\u20105"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010642\u201003882\u20102_243"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00132\u2010019\u201003752\u20103"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199405000-00004"},{"key":"e_1_2_9_10_2","first-page":"521","article-title":"Femoral neck anteversion: values, development, measurement, common problems","volume":"24","author":"Gulan G","year":"2000","journal-title":"Coll Antropol"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149480"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.137.1.97"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20858"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010194931030\u201000006"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10776\u2010003\u20100648\u20105"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005561\u20109"},{"key":"e_1_2_9_17_2","first-page":"379","article-title":"Les vices de torsion des membres inf\u00e9rieurs. 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February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"PM, GM, SC, BK, and RT have nothing to disclose. MO is an educational consultant for Stryker, New-clip and Arthrex. SL and AF are paid employee of stryker. RS is board member of ESSKA, and Consultant for Smith and Nephew.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The local ethics committee approved our study protocol prior to investigation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}