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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 3, 344-350.
doi: 10.1302/0301-620X.91B3.21592  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Is there a biomechanical explanation for anterior knee pain in patients with patella alta?

INFLUENCE OF PATELLAR HEIGHT ON PATELLOFEMORAL CONTACT FORCE, CONTACT AREA AND CONTACT PRESSURE

T. Luyckx, MD, Resident Orthopaedic Surgeon1; K. Didden, MD, Resident Orthopaedic Surgeon1; H. Vandenneucker, MD, Orthopaedic Surgeon1; L. Labey, MD, PhD, Research Engineer1; B. Innocenti, MD, Research Engineer1; and J. Bellemans, MD, PhD, Professor, Orthopaedic Surgeon1

1 University Hospital UZ Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.

Correspondence should be sent to Dr T. Luyckx; e-mail: luyckx.thomas{at}gmail.com

The purpose of this study was to test the hypothesis that patella alta leads to a less favourable situation in terms of patellofemoral contact force, contact area and contact pressure than the normal patellar position, and thereby gives rise to anterior knee pain.

A dynamic knee simulator system based on the Oxford rig and allowing six degrees of freedom was adapted in order to simulate and record the dynamic loads during a knee squat from 30° to 120° flexion under physiological conditions. Five different configurations were studied, with variable predetermined patellar heights.

The patellofemoral contact force increased with increasing knee flexion until contact occurred between the quadriceps tendon and the femoral trochlea, inducing load sharing. Patella alta caused a delay of this contact until deeper flexion. As a consequence, the maximal patellofemoral contact force and contact pressure increased significantly with increasing patellar height (p < 0.01). Patella alta was associated with the highest maximal patellofemoral contact force and contact pressure. When averaged across all flexion angles, a normal patellar position was associated with the lowest contact pressures.

Our results indicate that there is a biomechanical reason for anterior knee pain in patients with patella alta.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General