Patellofemoral stress during walking in persons with and without patellofemoral pain

Objective: To determine whether individuals with patellofemoral pain (PFP) demonstrate elevated patellofemoral joint (PFJ) stress compared with pain-free controls during free and fast walking. Design: A cross-sectional study utilizing an experimental and a control group. Background: Although the cause of PFJ pathology is believed to be related to elevated joint stress (force per unit area), this hypothesis has not been adequately tested and causative mechanisms have not been clearly defined. Methods: Ten subjects with a diagnosis of PFP and 10 subjects without pain participated. All subjects completed two phases of data collection: 1) magnetic resonance imaging (MRI) assessment to determine PFJ contact area and 2) comprehensive gait analysis during self-selected free and fast walking velocities. Data obtained from both phases were required as input variables into a biomechanical model to quantify PFJ stress. Results: On the average, PFJ stress was significantly greater in subjects with PFP compared with control subjects during level walking. The observed increase in PFJ stress in the PFP group was attributed to a significant reduction in PFJ contact area, as the PFJ reaction forces were similar between groups. Conclusion: Our results are consistent with the hypothesis that increased patellofemoral joint stress may be a predisposing factor with respect to development of PFP. Clinically, these findings indicate that treatments designed to increase the area of contact between the patella and the femur may be beneficial in reducing the PFJ stress during functional activities. Relevance: Patellofemoral pain affects about 25% of the population. yet its etiology is unknown. Knowledge of the biomechanical factors contributing to patellofemoral joint pain may improve treatment techniques and guide development of prevention strategies.