Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation

Abstract

Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.

Effects of Obesity on Medial Tibiofemoral Cartilage Mechanics in Females—An Exploration Using Musculoskeletal Simulation and Probabilistic Cartilage Failure Modelling

“…Cut-off frequencies were optimized using residual analysis for both kinetic and kinematics data [ 43 ]. The velocity of walking (m/s) was calculated as mean linear velocity of the model centre of mass in the anterior direction during the stance phase using Visual 3D [ 44 ]. Stride length (m) was determined as the linear anterior distance in the foot centre of mass location at footstrike between initial and subsequent ipsilateral footfalls [ 45 ].…”

“…For each biomechanical and cartilage failure outcome variable; means, standard deviations (SD) and 95% confidence intervals (95% CI) around the mean were calculated. To compare participant characteristics, biomechanical and cartilage failure outcomes between healthy weight and obese groups, between groups linear mixed effects models were adopted using the restricted maximum-likelihood method, with group (i.e., obese/healthy weight) included as a fixed factor and random intercepts modelled by participants [ 44 ]. Linear regression analysis was also adopted in both groups to determine the relationship between BMI and peak force, peak stress and peak strain.…”

Effects of Running in Minimal, Maximal and Conventional Footwear on Tibial Stress Fracture Probability: An Examination Using Finite Element and Probabilistic Analyses

“…We determined the probability of stress fracture for each participant in each footwear condition firstly by accounting for the daily running distance, which was included in the model as runners completing 5.0 km/day for 100 consecutive days [25,26,41]. The number of loading cycles/footfalls per day in each footwear condition was quantified by dividing the modelled daily running distance by the step length in each footwear outlined in the aforementioned running biomechanics section [45].…”

The efficacy of a tart cherry drink for the treatment of patellofemoral pain in recreationally active individuals: a placebo randomized control trial

“…Previous analyses have shown that those suffering from patellofemoral pain exhibit reduced knee joint range of motion as a compensatory strategy to decrease knee loading and reduce pain during sports movements [39,40]. This is an undesirable mechanism in active individuals, as it negatively affects the ability to perform functional sports movements effectively, making reductions in pain particularly important in this population from the standpoint of biomechanical function.…”