knee valgus

Influence of femur rotation and knee valgus on patellofemoral stress

Background: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice. A commonly cited hypothesis as to the cause of PFP is increased patellofemoral joint (PFJ) stress secondary to abnormal lower extremity kinematics (ie. excessive hip internal rotation and knee valgus). However, the influence of these motions on PFJ contact mechanics is unknown. Purpose: To assess the influence of hip rotation and knee valgus on PFJ stress using finite element (FE) analysis. Methods: Patella cartilage stress profiles for a healthy participant were quantified utilizing a subject-specific FE model. Input parameters included: joint geometry, quadriceps muscle forces, and weight-bearing PFJ kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify patella cartilage stress during a static squatting maneuver (45° knee flexion). To simulate hip rotation (0-8°) and knee valgus (0-12°), the femur and tibia were rotated in the transverse and frontal plane respectively in 2° increments. Results: Increasing hip rotation resulted in a linear increase in patella cartilage stress. In contrast, increasing knee valgus resulted in a decrease in patella cartilage stress. The combination of hip rotation and knee valgus did not result in higher PFJ cartilage stress compared to isolated hip rotation. Conclusions: Patella cartilage stress appears to be influenced to a greater degree by hip internal rotation as opposed to knee valgus. Surprisingly, higher degrees of knee valgus resulted in decreased cartilage stress (in the absence of hip rotation). Our finding supports the premise that persons exhibiting excessive hip internal rotation may be pre-disposed to elevated patella cartilage stress.
Listed In: Biomechanics, Gait, Physical Therapy