Utility of the Frontal Plane Projection Angle in Females With Patellofemoral Pain

Irene S. Davis, John D. Willson

DOI: 10.2519/jospt.2008.2706

STUDY DESIGN: Case-control study of females with patellofemoral pain syndrome (PFPS) and a control group. OBJECTIVES: Three different approaches were used to examine the utility of a 2-dimensional (2-D) frontal plane projection angle (FPPA) measure of knee alignment. First, we measured the FPPA association with respect to 3-dimensional (3-D) lower extremity joint rotations during single-leg squats. Second, we determined the correlation of the FPPA during single-leg squats with hip and knee joint rotations during running and single leg jumping.  Third, we compared the FPPA between females with and without PFPS. BACKGROUND: PFPS is associated with altered lower extremity kinematics during weight-bearing activities that decrease retropatellar contact area and increase retropatellar stress. An objective and simple procedure to quantify altered kinematics during weight-bearing activities may help clinicians identify individuals who may likely benefit from interventions to improve lower extremity kinematics. METHODS AND MEASURES: Twenty females with PFPS and 20 healthy female controls performed single-leg squats, running, and repetitive single-leg jumps while 3-D lower extremity kinematics were recorded. The FPPA was recorded by a digital camera during single-leg stance and single-leg squats. Correlation coefficients were used to quantify the association between the FPPA and transverse and frontal plane hip and knee angles for all activities. Independent t tests were used to compare FPPA values between groups. RESULTS: FPPA values representing medial displacement of the knee during single-leg squats were associated with increased hip adduction (r = 0.32 to 0.38, P<.044) and knee external rotation (r = 0.48 to 0.55, P<.001) across activities. FPPA values for the PFPS group reveal greater medial displacement of the knee compared with those of the control group during single-leg squats (P = .012). CONCLUSION: The association between the FPPA and lower extremity kinematics that are associated with PFPS suggest that the FPPA during single-leg squats may be a useful clinical measure. However, these methods should not be used to quantify 3-D joint rotations. LEVEL OF EVIDENCE: Level 5.

J Orthop Sports Phys Ther. 2008;38(10):606-615, published online 11 July 2008. doi:10.2519/jospt.2008.2706

KEY WORDS: anterior knee pain, kinematics, knee, patella, 2-dimensional analysis

The authors use three different approaches to examine the utility of a 2-dimensional (2-D) frontal plane projection angle (FPPA) measure of knee alignment.

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