Craigs test

Craig’s Test is a clinical assessment used to measure femoral anteversion, or the forward rotation of the femoral neck. It provides a functional estimate of femoral torsion and helps identify abnormalities in hip biomechanics [1].

Femoral anteversion plays a crucial role in hip stability, gait patterns, and knee alignment. Abnormal values can lead to conditions such as in-toeing gait, patellofemoral pain, hip impingement, and increased risk of ACL injuries [2][3].

Test procedure

Patient position

• The patient lies prone on the examination table.

• The hip remains in neutral position, and the knee of the tested limb is flexed to 90° [3].

Examiner position

• The examiner stands on the contralateral side of the tested hip.

• The examiner stabilizes the sacrum with the forearm.

• The cranial hand palpates the greater trochanter, while the caudal hand passively rotates the hip.

Execution

• The hip is passively internally rotated until the greater trochanter reaches its most lateral prominence.

• At this point, the leg is held still.

• The angle is measured between:

  • A line bisecting the medial and lateral malleoli (tibial axis).

  • A vertical line perpendicular to the examination table.

• The resulting angle represents the degree of femoral anteversion [3][4].

Interpretation

• Normal values:

  • At birth: ~30° anteversion.

  • Adults: 8–15° anteversion [5].

• Increased anteversion (>15°):

  • Associated with in-toeing gait, squinting patellae, patellofemoral pain, and hip instability.

  • More common in females.

• Decreased anteversion (<8°):

  • Indicates femoral retroversion.

  • May increase stress on the femoral neck and cause abnormal hip loading.

Clinical significance

Femoral anteversion directly affects hip and knee biomechanics:

• Hip and knee loading: High anteversion increases patellofemoral stress.

• Muscle activation: Changes leverage of hip muscles.

• Gait: Excessive anteversion often results in in-toeing gait with compensatory external tibial rotation.

• Injury risk: Linked to higher incidence of ACL rupture, femoroacetabular impingement (FAI), patellofemoral pain, and unilateral hip osteoarthritis [1][3].

Diagnostic validity and evidence

Reliability studies

Different measurement techniques have shown varying reliability in Craig’s test:

Method	Intra-rater reliability (ICC)	Inter-rater reliability (ICC)
Goniometer	0.82–0.86	0.25
Goniometer + laser beam	0.73–0.78	0.62
Inclinometer	0.72–0.74	0.27

• Laser-assisted goniometer demonstrated the best inter-rater reliability [2].

• A 2020 study found no significant correlation between Craig’s test and CT-based measurements of femoral anteversion [3].

• MRI-based studies have shown high intrarater reliability (ICC 0.88–0.90) [7].

Conclusion

Craig’s test is a simple and practical clinical tool for estimating femoral anteversion. However, it has limited diagnostic accuracy compared to imaging modalities such as CT or MRI. While useful in assessing hip biomechanics and patellofemoral dysfunction, the test shows variable inter-rater reliability and should therefore be interpreted with caution. For precise measurement, Craig’s test should be combined with radiological imaging when needed.

References

1. Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. Journal of Anatomy. 2020 Nov;237(5):811-26.

2. Choi BR, Kang SY. Intra-and inter-examiner reliability of goniometer and inclinometer use in Craig’s test. Journal of physical therapy science. 2015;27(4):1141-4.

3. Ito I, Miura K, Kimura Y, Sasaki E, Tsuda E, Ishibashi Y. 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. 2020;32(6):365-9.

4. Choi BR, Kang SY. Intra-and inter-examiner reliability of goniometer and inclinometer use in Craig’s test. Journal of physical therapy science. 2015;27(4):1141-4.

5. Epomedicine [Internet]. Clinical Skills and Approches. Femoral Anteversion test (Craig’s test). [updated 2020 Jun 27; cited 2021 Feb 28]. Available from: https://epomedicine.com/clinical-medicine/femoral-anteversion-craigs-test/

6. Clinical Physio. Craig's Test for Hip | Clinical Physio Premium. Available from: https://www.youtube.com/watch?v=Qi41LYsVy1E. [Lasted Accessed: 2021-2-26]

7. Souza RB, Powers CM. Concurrent criterion-related validity and reliability of a clinical test to measure femoral anteversion. Journal of orthopaedic & sports physical therapy. 2009 Aug;39(8):586-92.