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Archives of Orthopaedic and Trauma Surgery

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26-11-2022 | Patella Dislocation | Orthopaedic Surgery

Elevated hip adduction angles and abduction moments in the gait of adolescents with recurrent patellar dislocation

Authors: Elias Ammann, Rahel L. Meier, Erich Rutz, Kathrin Studer, Victor Valderrabano, Carlo Camathias

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2023

Abstract

Introduction

Impaired hip kinematics and kinetics may incite patellar instability. This study tested the hypothesis that hip adduction and internal rotation angles during gait are higher in adolescents with recurrent patellar dislocations compared to healthy controls.

Material and methods

Case–control study. Eighty-eight knees (67 patients) with recurrent patellar dislocation (mean age 14.8 years ± 2.8 SD) were compared to 54 healthy knees (27 individuals, 14.9 years ± 2.4 SD). Peak hip, knee and pelvis kinematics and kinetics were captured using 3D-gait analysis (VICON, 12 cameras, 200 Hz, Plug-in-Gait, two force plates) and compared between the two groups. One cycle (100%) consisted of 51 data points. The mean of six trials was computed.

Results

Peak hip adduction angles and abduction moments were significantly higher in patients with recurrent patellar dislocation compared to the control group (p < 0.001 and 0.002, respectively). Peak internal hip rotation did not differ significantly.

Conclusion

Elevated hip adduction angles and higher hip abduction moments in gait of adolescents with recurrent patellar dislocation may indicate an impaired function of hip abductors that contributes to patellar instability.

Imhoff FB, Cotic M, Dyrna FGE, Cote M, Diermeier T, Achtnich A, Imhoff AB, Beitzel K (2021) Dynamic Q-angle is increased in patients with chronic patellofemoral instability and correlates positively with femoral torsion. Knee Surg Sports Traumatol Arthrosc 29(4):1224–1231. https://doi.org/10.1007/s00167-020-06163-6CrossRefPubMed

Zeitoune G, Leporace G, Batista LA, Metsavaht L, Lucareli PRG, Nadal J (2020) Do hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners? Gait Posture 79:217–223. https://doi.org/10.1016/j.gaitpost.2020.05.006CrossRefPubMed

Camathias C, Ammann E, Meier RL, Rutz E, Vavken P, Studer K (2020) Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle. Knee Surg Sports Traumatol Arthrosc 28(7):2053–2066. https://doi.org/10.1007/s00167-020-05911-yCrossRefPubMed

Amis AA, Oguz C, Bull AMJ, Senavongse W, Dejour D (2008) The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Jt Surg Br 90:864–869. https://doi.org/10.1302/0301-620X.90B7.20447CrossRef

Kölle T, Alt W, Wagner D (2020) Effects of a 12-week home exercise therapy program on pain and neuromuscular activity in patients with patellofemoral pain syndrome. Arch Orthop Trauma Surg 140(12):1985–1992. https://doi.org/10.1007/s00402-020-03543-yCrossRefPubMed

Kölle T, Alt W, Wagner D (2020) Immediate effects of an elastic patellar brace on pain, neuromuscular activity and knee kinematics in subjects with patellofemoral pain. Arch Orthop Trauma Surg 140(7):905–912. https://doi.org/10.1007/s00402-020-03378-7CrossRefPubMed

Nadeau S, Gravel D, Hcbertb LJ, Arsenault AB, Lepage Y (1997) Gait study of patients with patellofemoral pain syndrome. Gait Posture 5(1):21–27. https://doi.org/10.1016/S0966-6362(96)01078-8CrossRef

Arazpour M, Bahramian F, Abutorabi A, SeyedNourbakhsh T, Alidousti A, Aslani H, Beheshti S (2016) The effect of patellofemoral pain syndrome on gait parameters: a literature review. Arch Bone Jt Surg 4:298–306. https://doi.org/10.22038/abjs.2016.7541CrossRefPubMedPubMedCentral

Barton CJ, Levinger P, Menz HB, Webster KE (2009) Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture 30:405–416. https://doi.org/10.1016/j.gaitpost.2009.07.109CrossRefPubMed

10.

Bolgla LA, Malone TR, Umberger BR, Uhl TL (2008) Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 38:12–18. https://doi.org/10.2519/jospt.2008.2462CrossRefPubMed

11.

Souza RB, Powers CM (2009) Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther 39:12–19. https://doi.org/10.2519/jospt.2009.2885CrossRefPubMed

12.

Meira EP, Brumitt J (2011) Influence of the hip on patients with patellofemoral pain syndrome: a systematic review. Sports Health 3:455–465. https://doi.org/10.1177/1941738111415006CrossRefPubMedPubMedCentral

13.

Powers CM (2010) The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 40:42–51. https://doi.org/10.2519/jospt.2010.3337CrossRefPubMed

14.

Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C (2012) Proximal and distal kinematics in female runners with patellofemoral pain. Clin Biomech 27:366–371. https://doi.org/10.1016/j.clinbiomech.2011.10.005CrossRef

15.

Herbst KA, Barber Foss KD, Fader L, Hewett TE, Witvrouw E, Stanfield D, Myer GD (2015) Hip strength is greater in athletes who subsequently develop patellofemoral pain. Am J Sports Med 43(11):2747–2752. https://doi.org/10.1177/0363546515599628CrossRefPubMedPubMedCentral

16.

Haghighat F, Ebrahimi S, Rezaie M, Shafiee E, Shokouhyan SM, Motealleh A, Parnianpour M (2021) Trunk, pelvis, and knee kinematics during running in females with and without patellofemoral pain. Gait Posture 89:80–85. https://doi.org/10.1016/j.gaitpost.2021.06.023CrossRefPubMed

17.

Stefanik JJ, Felson DT, Rabasa G, Guermazi A, Roemer F, Lynch J, Lewis CE, Torner J, Lewis CL (2021) Relation of hip abductor strength to worsening cartilage damage in the knee: the multicenter osteoarthritis study. Osteoarthr Cartil 29:399. https://doi.org/10.1016/j.joca.2021.02.517CrossRef

18.

Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N (2020) Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification. BMC Musculoskelet Disord 21(1):8. https://doi.org/10.1186/s12891-019-3022-1CrossRefPubMedPubMedCentral

19.

Dunn DM, Notley B (1952) Anteversion of the neck of the femur; a method of measurement. J Bone Joint Surg Br 34-B(2):181–186. https://doi.org/10.1302/0301-620X.34B2.181CrossRefPubMed

20.

Davis RB (1988) Clinical gait analysis. IEEE Eng Med Biol Mag 7:35–40. https://doi.org/10.1109/51.7933CrossRefPubMed

21.

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I (2002) Standardization and Terminology Committee of the International Society of Biomechanics. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion-part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech 35(4):543–548. https://doi.org/10.1016/s0021-9290(01)00222-6CrossRefPubMed

22.

Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–392. https://doi.org/10.1002/jor.1100080310CrossRefPubMed

23.

Perry J, Burnfield J (1992) Gait analysis: normal and pathological function. SLACK Incorporated, New Jersey

24.

Visscher R, Hasler N, Freslier M, Singh NB, Taylor WR, Brunner R, Rutz E (2021) Long-term follow-up after multilevel surgery in cerebral palsy. Arch Orthop Trauma Surg 142(9):2131–2138. https://doi.org/10.1007/s00402-021-03797-0CrossRefPubMed

25.

Ammann E, Meier RL, Rutz E, Vavken P, Studer K, Camathias C (2020) Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally. Knee Surg Sports Traumatol Arthrosc 28(7):2067–2076. https://doi.org/10.1007/s00167-020-05906-9CrossRefPubMed

26.

Stief F, Böhm H, Michel K, Schwirtz A, Döderlein L (2013) Reliability and accuracy in three-dimensional gait analysis: a comparison of two lower body protocols. J Appl Biomech 29(1):105–111. https://doi.org/10.1123/jab.29.1.105CrossRefPubMed

27.

Chotel F, Bérard J, Raux S (2014) Patellar instability in children and adolescents. Orthop Traumatol Surg Res 100(1 Suppl):125–137. https://doi.org/10.1016/j.otsr.2013.06.014CrossRef

28.

Dewan V, Webb MSL, Prakash D, Malik A, Gella S, Kipps C (2019) When does the patella dislocate? A systematic review of biomechanical & kinematic studies. J Orthop 16(20):70–77. https://doi.org/10.1016/j.jor.2019.11.018CrossRef

29.

Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33:677–685. https://doi.org/10.2519/jospt.2003.33.11.677CrossRefPubMed

30.

Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41(1):51–57. https://doi.org/10.1177/0363546512464691CrossRefPubMed

31.

Tian G, Yang G, Zuo L, Li F, Wang F (2020) Femoral derotation osteotomy for recurrent patellar dislocation. Arch Orthop Trauma Surg 140(12):2077–2084. https://doi.org/10.1007/s00402-020-03598-xCrossRefPubMed

32.

Dierks TA, Manal KT, Hamill J, Davis IS (2008) Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 38:448–456. https://doi.org/10.2519/jospt.2008.2490CrossRefPubMed

33.

Reiman MP, Bolgla LA, Lorenz D (2009) Hip function’s influence on knee dysfunction: a proximal link to a distal problem. J Sports Rehabil 18:33–46. https://doi.org/10.1123/jsr.18.1.33CrossRef

34.

Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, Schüttrumpf JP, Stürmer KM (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22(10):2308–2314. https://doi.org/10.1007/s00167-013-2650-5CrossRefPubMed

35.

Ling DI, Brady JM, Arendt E, Tompkins M, Agel J, Askenberger M, Balcarek P, Parikh S, Shubin Stein BE (2021) Development of a multivariable model based on individual risk factors for recurrent lateral patellar dislocation. J Bone Jt Surg Am. 103(7):586–592. https://doi.org/10.2106/JBJS.20.00020CrossRef

36.

Butler RJ, Barrios JA, Royer T, Davis IS (2011) Frontal-plane gait mechanics in people with medial knee osteoarthritis are different from those in people with lateral knee osteoarthritis. Phys Ther 91(8):1235–1243. https://doi.org/10.2522/ptj.20100324CrossRefPubMedPubMedCentral

37.

Rutherford DJ, Hubley-Kozey C, Stanish W (2014) Hip abductor function in individuals with medial knee osteoarthritis: implications for medial compartment loading during gait. Clin Biomech 29:545–550. https://doi.org/10.1016/j.clinbiomech.2014.03.009CrossRef

38.

Chang A, Hayes K, Dunlop D, Song J, Hurwitz D, Cahue S, Sharma L (2005) Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis Rheum 52:3515–3519. https://doi.org/10.1002/art.21406CrossRefPubMed

39.

Dunphy C, Casey S, Lomond A, Rutherford D (2016) Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals. Hum Mov Sci 49:27–35. https://doi.org/10.1016/j.humov.2016.05.008CrossRefPubMed

40.

Boswell MA, Uhlrich SD, Kidziński Ł, Thomas K, Kolesar JA, Gold GE, Beaupre GS, Delp SL (2021) A neural network to predict the knee adduction moment in patients with osteoarthritis using anatomical landmarks obtainable from 2D video analysis. Osteoarthr Cartil 29(3):346–356. https://doi.org/10.1016/j.joca.2020.12.017CrossRef

41.

Li S, Ng WH, Abujaber S, Shaharudin S (2021) Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis. Sci Rep 11(1):16104. https://doi.org/10.1038/s41598-021-95426-4CrossRefPubMedPubMedCentral

42.

Ruescas Nicolau AV, De Rosario H, Basso Della-Vedova F, Parrilla Bernabé E, Juan MC, López-Pascual J (2022) Accuracy of a 3D temporal scanning system for gait analysis: comparative with a marker-based photogrammetry system. Gait Posture 97:28–34. https://doi.org/10.1016/j.gaitpost.2022.07.001CrossRefPubMed

43.

Van der Kruk E, Reijne MM (2018) Accuracy of human motion capture systems for sport applications; state-of-the-art review. Eur J Sport Sci 18(6):806–819. https://doi.org/10.1080/17461391.2018.1463397CrossRefPubMed

44.

Colyer SL, Evans M, Cosker DP, Salo AIT (2018) A review of the evolution of vision-based motion analysis and the integration of advanced computer vision methods towards developing a markerless system. Sports Med Open 4(1):24. https://doi.org/10.1186/s40798-018-0139-yCrossRefPubMedPubMedCentral

45.

Huntington LS, Webster KE, Devitt BM, Feller JA (2021) Risk assessment and management of primary patellar dislocation is complex and multifactorial: a survey of Australian knee surgeons. J ISAKOS 6(6):333–338. https://doi.org/10.1136/jisakos-2020-000609CrossRefPubMed

46.

Smith TO, Donell ST, Chester R, Clark A, Stephenson R (2011) What activities do patients with patellar instability perceive makes their patella unstable? Knee 18(5):333–339. https://doi.org/10.1016/j.knee.2010.07.003CrossRefPubMed

Title: Elevated hip adduction angles and abduction moments in the gait of adolescents with recurrent patellar dislocation
Authors: Elias Ammann
Rahel L. Meier
Erich Rutz
Kathrin Studer
Victor Valderrabano
Carlo Camathias
Publication date: 26-11-2022
Publisher: Springer Berlin Heidelberg
Keyword: Patella Dislocation
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04703-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Elevated hip adduction angles and abduction moments in the gait of adolescents with recurrent patellar dislocation

Abstract

Introduction

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusion

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