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Patellofemoral Joint Kinematics in Individuals with and without Patellofemoral Pain Syndrome

¹ School of Rehabilitation Therapy, 31 George Street, LD Acton Building, Room 222, Queen's University, Kingston, ON K7L 3N6, Canada
² Department of Mechanical Engineering and Human Mobility Research Centre, Queen's University, Apps Wing, Doran 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
³ Surgical Planning Laboratory, Department of Radiology, Room ASBI, L1-050, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
⁴ Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health Research Institute, 910 West 10th Avenue, Room 3114, Vancouver, BC V5Z 4E3, Canada

Investigation performed at the Human Mobility Research Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Canadian Institutes of Health Research (CIHR MOP43883), the Natural Sciences and Engineering Research Council of Canada (Strategic Grant), the Ontario Centres of Excellence, the Ontario Research Fund, the Physiotherapy Foundation of Canada (AMMFOP), the Arthritis Society/Canadian Institutes of Health Research (research fellowship for N.J.MacI.), and the Canadian Arthritis Network (scholarship for D.R.W.). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Three-dimensional patellofemoral joint kinematics in one knee of each of sixty volunteers (twenty in each group described above) were assessed with use of a new, validated magnetic resonance imaging-based method. Static low-resolution scans of the loaded knee were acquired at five different angles of knee flexion (ranging between –4° and 60°). High-resolution geometric models of the patella, femur, and tibia and associated coordinate axes were registered to the bone positions on the low-resolution scans to determine the patellar motion as a function of knee flexion angle. Hierarchical modeling was used to identify group differences in patterns of patellar spin, tilt, and lateral translation.

Results: No differences in the overall pattern of patellar motion were observed among groups (p > 0.08 for all global maximum likelihood ratio tests). Features of patellar spin and tilt patterns varied greatly between subjects across all three groups, and no significant group differences were detected. At 19° of knee flexion, the patellae in the group with patellofemoral pain and clinical evidence of malalignment were positioned an average of 2.25 mm more laterally than the patellae in the control group, and this difference was marginally significant (p = 0.049). Other features of the pattern of lateral translation did not differ, and large overlaps in values were observed across all groups.

Conclusions: It cannot be determined from our cross-sectional study whether the more lateral position of the patella in the group with clinical evidence of malalignment preceded or followed the onset of symptoms. It is clear from the data that an individual with patellofemoral pain syndrome cannot be distinguished from a control subject by examining patterns of spin, tilt, or lateral translation of the patella, even when clinical evidence of mechanical abnormality was observed.

Clinical Relevance: Since most patients with patellofemoral pain syndrome did not demonstrate abnormalities in patellar tracking during loaded knee flexion, other causative mechanisms must be explored to develop effective diagnostic and treatment strategies for this common musculoskeletal condition.

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