Journal of The Korean Society of Integrative Medicine (대한통합의학회지)

Korean Society of Integrative Medicine (대한통합의학회)
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Relationship of the Frontal Knee Alignment Measured by the HKA-Angle with the Relative Activation of the Quadriceps Muscles

  • Kim, Jaehee (Dept. of Physical Therapy, Konyang University) ;
  • Bae, Jinsol (Dept. of Physical Therapy, Konyang University) ;
  • Lee, Yesol (Dept. of Physical Therapy, Konyang University) ;
  • Lee, Nakyung (Dept. of Physical Therapy, Konyang University)
  • Received : 2016.10.31
  • Accepted : 2016.12.12
  • Published : 2016.12.30
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Abstract

Purpose: The purpose of this study was to compare Hip-Knee-Ankle(HKA) angle and muscle activation ratio between vastus medialis(VM), rectus femoris(RF), and vastus lateralis (VL), and by this, to examine their relationship. It is aimed to explore how the activation ratio among the muscles involved in patellofemoral kinetics would vary in relation with the frontal alignment of the lower extremity. Subjects and Methods: 26 healthy subjects were recruited for the study. The HKA angles were measured with radiograph. The VM, RF, VL muscle activation level were measured by surface electromyography while each participant performed 4 different types of movement (isometric knee extension, squat, ambulation, step-up) and VM/RF, VM/VL, RF/VL ratios were calculated. Pearson correlation was used to estimate the relationship between the HKA angle and the muscle ratio. Results: There was significant moderate correlation between HKA angle and VM: RF on the left side during ambulation (p<0.05). Moderate correlations were also observed during step-up and squat with less significance (p<0.1). Conclusion: The frontal alignment of the knee measured by the HKA angle was conditionally associated with muscle activation ratio between VM and RF (VM:RF); On the left, during ambulation, step-up, and squat, the more valgus knee tended to correlate with the more VM muscle activation ratio, which is expected to induce more stabilizing effect to the patella and its tracking. It suggests that the frontal alignement measured by the HKA-angle can affect PF kinetics. It also indicates a possibility that increase in valgus alignment of the knee, by the HKA measurement, may not act unfavorably to generate PFP.

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References

  1. Alba-Martin P, Gallego-Izquierdo T, Plaza-Manzano G, et al(2015). Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: A systematic review. J Phys Ther Sci, 27(7), 2387-2390. https://doi.org/10.1589/jpts.27.2387
  2. Bolgla LA, Boling MC(2011). An update for the conservative management of patellofemoral pain syndrome: A systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther, 6(2), 112-125.
  3. Bolgla LA, Malone TR, Umberger BR, et al(2008). Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther, 38(1), 12-18. https://doi.org/10.2519/jospt.2008.2462
  4. Cooke TD, Sled EA, Scudamore RA(2007). Frontal plane knee alignment: A call for standardized measurement. J Rheumatol, 34(9), 1796-1801.
  5. Dierks TA, Manal KT, Hamill J, et al(2008). Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther, 38(8), 448-456. https://doi.org/10.2519/jospt.2008.2490
  6. Fagan V, Delahunt E(2008). Patellofemoral pain syndrome: A review on the associated neuromuscular deficits and current treatment options. Br J Sports Med, 42(10), 789-795.
  7. Ferrari D, Kuriki HU, Silva CR, et al(2014). Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome. Arch Phys Med Rehabil, 95(8), 1521-1526. https://doi.org/10.1016/j.apmr.2014.03.028
  8. Fredericson M, Yoon K(2006). Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil, 85(3), 234-243. https://doi.org/10.1097/01.phm.0000200390.67408.f0
  9. Freedman BR, Brindle TJ, Sheehan FT(2014). Re-evaluating the functional implications of the q-angle and its relationship to in-vivo patellofemoral kinematics. Clin Biomech (Bristol, Avon), 29(10), 1139-1145. https://doi.org/10.1016/j.clinbiomech.2014.09.012
  10. Fulkerson JP(2002). Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med, 30(3), 447-456. https://doi.org/10.1177/03635465020300032501
  11. Herrington L(2014). Knee valgus angle during single leg squat and landing in patellofemoral pain patients and controls. Knee, 21(2), 514-517. https://doi.org/10.1016/j.knee.2013.11.011
  12. Levangie PK, Norkin CC(2011). Joint structure and function: A comprehensive analysis. 5th ed, F. A. Davis Company, pp.484-508.
  13. Liebensteiner MC, Szubski C, Raschner C, et al(2008). Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome. Knee, 15(3), 180-186. https://doi.org/10.1016/j.knee.2008.01.009
  14. Messier SP, Davis SE, Curl WW, et al(1991). Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc, 23(9), 1008-1015.
  15. Moss RI, Devita P, Dawson ML(1992). A biomechanical analysis of patellofemoral stress syndrome. J Athl Train, 27(1), 64-69.
  16. Myer GD, Ford KR, Foss KD, et al(2014). A predictive model to estimate knee-abduction moment: Implications for development of a clinically applicable patellofemoral pain screening tool in female athletes. J Athl Train, 49(3), 389-398. https://doi.org/10.4085/1062-6050-49.2.17
  17. Nagano H, Begg RK, Sparrow WA, et al(2011). Ageing and limb dominance effects on foot-ground clearance during treadmill and overground walking. Clin Biomech (Bristol, Avon), 26(9), 962-968. https://doi.org/10.1016/j.clinbiomech.2011.05.013
  18. Ott B, Cosby NL, Grindstaff TL, et al(2011). Hip and knee muscle function following aerobic exercise in individuals with patellofemoral pain syndrome. J Electromyogr Kinesiol, 21(4), 631-637. https://doi.org/10.1016/j.jelekin.2011.04.006
  19. Pal S, Draper CE, Fredericson M, et al(2011). Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med, 39(3), 590-598. https://doi.org/10.1177/0363546510384233
  20. Park SK, Stefanyshyn DJ(2011). Greater q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech(Bristol, Avon), 26(4), 392-396. https://doi.org/10.1016/j.clinbiomech.2010.11.015
  21. Pattyn E, Verdonk P, Steyaert A, et al(2011). Vastus medialis obliquus atrophy: Does it exist in patellofemoral pain syndrome? Am J Sports Med, 39(7), 1450-1455. https://doi.org/10.1177/0363546511401183
  22. Petersen W, Ellermann A, Gosele-Koppenburg A, et al(2014). Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc, 22(10), 2264-2274. https://doi.org/10.1007/s00167-013-2759-6
  23. Post WR(1999). Clinical evaluation of patients with patellofemoral disorders. Arthroscopy, 15(8), 841-851. https://doi.org/10.1053/ar.1999.v15.015084
  24. Powers CM, Ward SR, Fredericson M, et al(2003). Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: A preliminary study. J Orthop Sports Phys Ther, 33(11), 677-685. https://doi.org/10.2519/jospt.2003.33.11.677
  25. Prins MR, van der Wurff P(2009). Females with patellofemoral pain syndrome have weak hip muscles: A systematic review. Aust J Physiother, 55(1), 9-15. https://doi.org/10.1016/S0004-9514(09)70055-8
  26. Rice J, Seeley MK(2010). An investigation of lower-extremity functional asymmetry for non-preferred able-bodied walking speeds. Int J Exerc Sci, 3(4), 182-188.
  27. Salsich GB, Graci V, Maxam DE(2012). The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. J Orthop Sports Phys Ther, 42(12), 1017-1024. https://doi.org/10.2519/jospt.2012.4231
  28. Sharma L, Song J, Felson DT, et al(2001). The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 286(2), 188-195. https://doi.org/10.1001/jama.286.2.188
  29. Sheehan FT, Derasari A, Brindle TJ, et al(2009). Understanding patellofemoral pain with maltracking in the presence of joint laxity: Complete 3d in vivo patellofemoral and tibiofemoral kinematics. J Orthop Res, 27(5), 561-570. https://doi.org/10.1002/jor.20783
  30. Sheehan FT, Derasari A, Fine KM, et al(2010). Q-angle and j-sign: Indicative of maltracking subgroups in patellofemoral pain. Clin Orthop Relat es, 468(1), 266-275. https://doi.org/10.1007/s11999-009-0880-0
  31. Tsakoniti AE, Stoupis CA, Athanasopoulos SI(2008). Quadriceps cross-sectional area changes in young healthy men with different magnitude of Q angle. J Appl Physiol, 105(3), 800-804. https://doi.org/10.1152/japplphysiol.00961.2007
  32. Uetake T(1992). Can we really walk straight? Am J Phys Anthropol, 89(1), 19-27. https://doi.org/10.1002/ajpa.1330890104
  33. Wilson NA, Press JM, Koh JL, et al(2009). In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am, 91(3), 558-566. https://doi.org/10.2106/JBJS.G.00572
  34. Yim JY, Yim HS, Park DS, et al(2016). Surface topographic measurement method for assessing lower extremity alignment: Examination on a novel clinical and research Tool. J Rehabil Welfare Eng Assistive Technoogyl, 10(1), 37-45.