A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome The Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) Cohort

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 09/2009; 37(11):2108-16. DOI: 10.1177/0363546509337934
Source: PubMed


Patellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury.
Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors.
Cohort study (prognosis); Level of evidence, 2.
A total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle).
Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome.
Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation. To decrease the incidence of this chronic injury, the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs.
Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.

Download full-text


Available from: Michelle C Boling,
  • Source
    • "Patellofemoral pain syndrome (PFPS) is characterized by pain around the patella mainly at activities that load the patellofemoral joint like bending knees, walking stairs, or kneeling. The origin of the complaints is not fully understood although weakness and/or tightness of the extensor muscles, changes in medial and lateral quadriceps muscle reflex time, patellar laxity, and increased navicular drop are suggested to be associated with PFPS (Witvrouw et al. 2000; Boling et al. 2009). "

  • Source
    • "Masciocchi). in adolescents and young adults [1] [2] [3] [4]. Normally, these pathologies manifest themselves in different clinical entities, from overt dislocation to isolated anterior knee pain present in or around the patello-femoral joint [1] [5] [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Aim of our work was to compare standard and weight-bearing WB-MRI to define their contribution in unmasking patello-femoral (PF) maltracking and to define what measurement of patellar alignment is the most reliable. Methods: We prospectively collected 95 non consecutive patients, clinically divided into 2 groups: group A (the control group), including 20 patients (negative for patellar maltracking), and group B including 75 patients (positive for patellar maltracking). The patients underwent a dedicated 0.25T MRI, in supine and WB position, with knee flexion of 12-15°. The following measurements were performed: Insall-Salvati index (IS), lateral patellar displacement (LPD), lateral patello-femoral angle (LPA) and lateral patellar tilt (LPT). Quantitative and qualitative statistical analyses were performed to compare the results obtained before and after WB-MRI. Measurements were subsequently performed on both groups. Results: Group A patients showed no statistically significant variations at all measurements both on standard and WB-MRI. On the basis of measurements made on standard MRI, group B patients were divided into group B1 (23 patients) (negative or positive at 1 measurement) and group B2 (52 patients) (positive at 2 or more measurements). After WB-MRI, group B1 patients were divided into group B1a (6 patients), in case they remained positive at 0/1 measurement, and group B1b (17 patients), in case they became positive at 2 or more measurements. All group B2 patients confirmed to be positive at 2 or more measurements at WB-MRI. Quantitative statistical analysis showed that LPT and LPA were the most reproducible and clinically useful measurements. Qualitative statistical analysis performed on standard and WB-MRI demonstrated that LPT was the best predictive measurement. Conclusions: This study demonstrates both the high diagnostic value of WB-MRI in unmasking PF-maltracking and the best predictive value of LPT measurement.
    European journal of radiology 10/2015; 84(12). DOI:10.1016/j.ejrad.2015.09.017 · 2.37 Impact Factor
    • "It has been theorized that these proximal compensations, associated with foot misalignments , could significantly influence patellofemoral joint mechanics and contribute to the development of patellofemoral pain (PFP) (Tiberio, 1987; Powers, 2003). Supporting these theories, prospective studies have demonstrated that FV and subtalar hyperpronation are risk factors for the development of PFP (Lun et al., 2004; Boling et al., 2009). However, very few studies have "
    [Show abstract] [Hide abstract]
    ABSTRACT: Foot misalignments, such as forefoot varus (FV), have been associated with musculoskeletal injuries in the proximal joints of the lower limb. Previous theories suggested that this association occurs because FV influences knee and hip kinematics during closed kinetic chain activities. However, research on the effects of FV in the kinematics of the lower limb is very scarce. Therefore, the purpose of this study was to compare the knee and hip kinematics between subjects with and without FV during a functional weight-bearing activity. Forty-six healthy adolescents were divided into two groups: group of subjects with FV (VG, n=23) and group of subjects with aligned forefoot (CG, n=23). A kinematic evaluation was conducted while the subjects performed a single-leg squat task. The variables of interest were hip internal rotation and adduction and knee abduction excursions at 15°, 30°, 45° and 60° of knee flexion. Between-group comparisons were performed with multivariate analysis of variance. Results showed that the VG presented greater hip internal rotation when compared with the CG across all evaluated knee flexion angles (P=0.02–0.0001). No differences between groups were observed in hip adduction or knee abduction (P>0.05). These results indicate that FV influences the transverse plane hip movement patterns during a functional weight-bearing activity. Considering that excessive hip internal rotation has been associated with knee injuries, these findings might contribute for a better understanding of the link between FV and injuries of the proximal joints of the lower limb.
    Manual Therapy 02/2015; 20(1):79-83. DOI:10.1016/j.math.2014.07.001 · 1.71 Impact Factor
Show more