The patient is positioned in prone with the knee flexed to 90 degrees.
The clinician rotates the hip through the full ranges of hip internal and external rotation, while palpating the greater trochanter and determining the point in the range at which the greater trochanter is the most prominent laterally.
How to measure the femoral anteversion angle with Craig Test?
The femoral anteversion angle can be measured when the greater trochanter is most prominent laterally.
If at this point the angle is greater than 8–15 degrees in the direction of internal rotation, when measured from the vertical and long axis of the tibia, the femur is considered to be in anteversion.
The femoral anteversion angle can be estimated directly on the basis of the angle by which the lower leg deviates from the vertical. In this position, the femoral neck lies in the horizontal plane while the condyles of the knee and the lower leg indicate the anteversion angle.
The precision of this measurement performed by an experienced examiner is comparable to that of radiographic measurement.
Craig Test Accuracy
One study 1 showed this test to be accurate to within 4 degrees of intraoperative measurements, for the assessment of femoral anteversion/retroversion, and was more accurate than radiographic measurement techniques.
Torsion angle of Femur
The torsion angle of the femur describes the relative rotation that exists between the shaft and the neck of the femur.
Normally, as viewed from above, the femoral neck projects on average 5–15 degrees anterior to a mediolateral axis to the femoral condyles.
Anteversion: An anterior orientation of the femoral neck to the transverse axis of the femoral condyles.
Retroversion: a reverse orientation (posterior) of the femoral neck to the transverse axis of the femoral condyles.
The normal range for femoral alignment in the transverse plane in adults is 5 degrees of anteversion.
Typically, an infant is born with about 30 degrees of femoral anteversion. This angle usually decreases to 15 degrees by 6 years of age because of bone growth and increased muscle activity.
Subjects with excessive anteversion usually have more hip internal rotation ROM than external rotation, and gravitate to the typical “frog-sitting” posture as a position of comfort. There is also associated in-toeing while weight-bearing.
Excessive anteversion directs the femoral head toward the anterior aspect of the acetabulum when the femoral condyles are aligned in their normal orientation.
Some studies have supported the hypothesis that a persistent increase in femoral anteversion predisposes to osteoarthritis (OA) of the hip and knee, although other studies have refuted this.
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Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.