Cam Morphology Is Associated With Increased Femoral Version: Findings From a Collection of 1,321 Cadaveric Femurs


      To evaluate the relationship between femoral version (FV) and α angle (AA) in a large osteological collection of human femurs.


      The University of Iowa-Stanford osteological collection was used to evaluate the research aims. To measure FV and AA, axial photographs of the proximal femurs were taken, referenced from the posterior condylar axis. FV and AA measurements were obtained using ImageJ software, and the relationship between FV and AA was assessed with repeated-measures analysis of variance and generalized linear models. A P value of <.05 was considered statistically significant.


      A total of 1321 cadaveric femurs (666 left and 655 right) in 721 cadavers were examined. The average AA for all femurs was 47.8° ± 10.9°, and the average FV for all femurs was 8.53° ± 8.09°. Overall, 191 femurs (14.5%) exhibited cam morphology (AA ≥ 60°). Of the 721 cadavers, 600 had both femurs available for side-to-side comparison. The average FV of femurs with cam morphology was significantly higher than that of femurs without cam morphology (11.70° ± 8.82° vs. 7.99° ± 8.82°, P < .001). Linear regression analysis demonstrated that increased AA was significantly correlated with increased FV (β ± standard error of the mean = 0.21 ± 0.02, P < .0001).


      In a large osteological collection of human femurs, a significant positive relationship between AA and increasing FV was identified.

      Clinical Relevance

      FAI and hip impingement morphology are more complex than cam or pincer morphology. Cam morphology with high femoral anteversion may allow for normal or near-normal hip mechanics without impingement, and this may partially explain the high rates of asymptomatic cam-type femoroacetabular impingement (FAI) morphology in active and general populations. Given the multiple morphological factors implicated in the development of FAI syndrome, these findings warrant further investigation.
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