In the JournalsPerspective

Hip, knee mechanics may contribute to patellofemoral pain in young female athletes

gregory Myer headshot
Gregory D. Myer

Maladaptive hip mechanics before puberty may contribute to patellofemoral pain in young female athletes, while aberrant knee mechanics may contribute to patellofemoral pain development throughout the maturational process, according to published results.

Gregory D. Myer, PhD, FACSM, CSCS*D, and colleagues had 506 high school female athletes who completed the anterior knee pain scale and a knee examination for the diagnosis of patellofemoral pain perform a drop vertical jump task instrumented with force plates at sport-specific preseason appointments during the course of 2 years. Researchers also documented pubertal status, landing profile and patellofemoral pain development. Participants were classified into high- or low-risk knee and hip landing profiles for the development of patellofemoral pain using biomechanical measures generated from standard 3-D biomechanical analyses. Researchers used sagittal-plane knee range of motion, peak knee abduction angle, peak knee abduction moment and peak-to-peak transverse-plane knee moment in the knee landing profile, and sagittal-plane hip range of motion, peak hip extensor moment, peak abductor moment and peak hip rotator moment in the hip landing profile.

Results showed increased hip flexion and decreased abductor, rotator and extensor moments among female athletes with high-risk hip landing profiles and showed decreased knee flexion and increased knee abduction, external abductor and external rotator moments among female athletes with high-risk knee landing profiles. Researchers noted higher odds of moving to a low-risk hip landing profile among participants with a high-risk hip landing profile who transitioned to post-pubertal status at follow-up vs. participants who had not reached post-pubertal status at follow-up. According to results, no association was found between pubertal maturation and change in the high-risk knee landing profile at follow-up.

“The results from this study indicate that before puberty in young girls, maladaptive hip mechanics may contribute to [patellofemoral pain] PFP, while aberrant knee mechanics may continue to contribute to PFP development during maturational stages in young female athletes,” Myer told Healio.com/Orthopedics. “In young girls, pubertal maturation status may have a protective effect on high-risk hip landing mechanics, while high-risk knee landing mechanics tend to endure during maturational process. Female athletes may benefit from hip targeted exercises prior to puberty and more global (hip and knee focused) neuromuscular training following pubertal maturation to reduce their risk to develop PFP.” – by Casey Tingle

 

Disclosure: Funding support was received from the National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH.

gregory Myer headshot
Gregory D. Myer

Maladaptive hip mechanics before puberty may contribute to patellofemoral pain in young female athletes, while aberrant knee mechanics may contribute to patellofemoral pain development throughout the maturational process, according to published results.

Gregory D. Myer, PhD, FACSM, CSCS*D, and colleagues had 506 high school female athletes who completed the anterior knee pain scale and a knee examination for the diagnosis of patellofemoral pain perform a drop vertical jump task instrumented with force plates at sport-specific preseason appointments during the course of 2 years. Researchers also documented pubertal status, landing profile and patellofemoral pain development. Participants were classified into high- or low-risk knee and hip landing profiles for the development of patellofemoral pain using biomechanical measures generated from standard 3-D biomechanical analyses. Researchers used sagittal-plane knee range of motion, peak knee abduction angle, peak knee abduction moment and peak-to-peak transverse-plane knee moment in the knee landing profile, and sagittal-plane hip range of motion, peak hip extensor moment, peak abductor moment and peak hip rotator moment in the hip landing profile.

Results showed increased hip flexion and decreased abductor, rotator and extensor moments among female athletes with high-risk hip landing profiles and showed decreased knee flexion and increased knee abduction, external abductor and external rotator moments among female athletes with high-risk knee landing profiles. Researchers noted higher odds of moving to a low-risk hip landing profile among participants with a high-risk hip landing profile who transitioned to post-pubertal status at follow-up vs. participants who had not reached post-pubertal status at follow-up. According to results, no association was found between pubertal maturation and change in the high-risk knee landing profile at follow-up.

“The results from this study indicate that before puberty in young girls, maladaptive hip mechanics may contribute to [patellofemoral pain] PFP, while aberrant knee mechanics may continue to contribute to PFP development during maturational stages in young female athletes,” Myer told Healio.com/Orthopedics. “In young girls, pubertal maturation status may have a protective effect on high-risk hip landing mechanics, while high-risk knee landing mechanics tend to endure during maturational process. Female athletes may benefit from hip targeted exercises prior to puberty and more global (hip and knee focused) neuromuscular training following pubertal maturation to reduce their risk to develop PFP.” – by Casey Tingle

 

Disclosure: Funding support was received from the National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH.

    Perspective
    Sanjeev Bhatia

    Sanjeev Bhatia

    It is well known in the literature that abnormal or limited movement patterns involving the hip and trunk are associated with an increased risk of noncontact ACL injuries at the knee. In this investigation, the authors aimed to focus more on how hip and trunk strength may affect patellofemoral pain syndrome in adolescent girls. Specifically, they identified neuromuscular control mechanism profiles associated with the development of patellofemoral pain and evaluated if these risk profiles changed with pubertal maturation. 

    The authors found that high-risk hip mechanics, implicated in the development of patellofemoral pain, decreased as girls progressed through puberty. However, they noted that high-risk knee mechanics did not change with pubertal maturation. Such findings may suggest that neuromuscular optimization efforts, particularly those focused on the knee, should be initiated in early adolescence as knee protective mechanisms for the development of patellofemoral pain do not naturally develop with puberty. 
    ACL injury prevention programs for adolescent athletes, especially adolescent girls, has been shown to be beneficial in reducing “at-risk” landing positions by optimizing neuromuscular control and proprioception. Studies like this suggest similar efforts may also be useful for the development of patellofemoral pain, a common problem in this demographic. 

    • Sanjeev Bhatia, MD
    • Orthopedic surgeon – sports medicine and hip arthroscopy
      Northwestern Medicine & Feinberg School of Medicine
      Warrenville, Illinois

    Disclosures: Bhatia reports he is a paid consultant for Edge Surgical and Graymont Medical; has stock or stock options in Joint Preservation Innovations LLC, Verical and Intuitive Surgical; and receives publishing royalties from Nova Science Publishers.