Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages2053–2066(2020)Cite this article

Abstract

Purpose

To evaluate the kinematics/kinetics of the ankle, knee, hip in the sagittal plane in adolescents with recurrent patellar dislocation in comparison to a healthy control.

Methods

Case–control study. Eighty-eight knees (67 patients) with recurrent patellar dislocation (mean age 14.8 years ± 2.8 SD) were compared to 54 healthy knees (27 individuals, 14.9 years  ± 2.4 SD). Kinematics/kinetics of ankle, knee, hip, and pelvis were captured using 3D-gait analysis (VICON, 12 cameras, 200 Hz, Plug-in-Gait, two force plates). One cycle (100%) consisted of 51 data-points. The mean of six trials was computed.

Results

The loading-response increased by 0.02 s ± 0.01SE (10.8%) with dislocations (0.98% of total gait, P < 0.01). The mid-stance-phase decreased equally (P < 0.01). Dislocation decreased knee flexion during the entire gait cycle (P < 0.01), with the largest difference during mid-stance (9.0° ± 7.2 SD vs. 18.5° ± 6.7 SD). Dislocation increased plantar-flexion during loading response 4.1° ± 0.4 SE with (P < 0.01), afterward, the dorsal-extension decreased 3.2° ± 0.3 SE, (P < 0.01). Dislocation decreased hip flexion during all phases (P < 0.01). Maximal difference: 7.5° ± 0.5 SE during mid-stance. 80% of all patients developed this gait pattern.

Internal moments of the ankle increased, of the knee and hip decreased during the first part of stance.

Conclusion

Recurrent patellar dislocation decreases knee flexion during the loading-response and mid-stance phase. A decreased hip flexion and increased plantar-flexion, while adjusting internal moments, indicate a compensation mechanism.

Level of evidence

III.

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Author information

Affiliations

  1. Paediatric Orthopaedic Department, University Children’s Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland

    Erich Rutz

  2. Praxis Zeppelin, Brauerstrasse 95, 9016, St. Gallen, Switzerland

    Carlo Camathias & Kathrin Studer

  3. Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Carlo Camathias & Patrick Vavken

  4. Basel Medical School, University of Basel, Petersplatz 1, 4003, Basel, Switzerland

    Carlo Camathias, Elias Ammann, Rahel L. Meier & Erich Rutz

  5. Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland

    Elias Ammann

  6. ADUS Klinik, Breitestrasse 11, 8157, Dielsdorf, Switzerland

    Patrick Vavken

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  1. Carlo Camathias
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  2. Elias Ammann
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Correspondence to Carlo Camathias.

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Camathias, C., Ammann, E., Meier, R.L. et al. Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle. Knee Surg Sports Traumatol Arthrosc 28, 2053–2066 (2020). https://doi.org/10.1007/s00167-020-05911-y

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Keywords

  • Patella dislocation
  • Patellar dislocation
  • Recurrent dislocation
  • Knee
  • Kinematics
  • Kinetics
  • Gait analysis
  • Quadriceps avoidance
  • Adolescents
  • Trochlear dysplasia