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Knee Surg Sports Traumatol Arthrosc. 2020 Mar 4. doi: 10.1007/s00167-020-05911-y. [Epub ahead of print]

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

Author information

1
Praxis Zeppelin, Brauerstrasse 95, 9016, St. Gallen, Switzerland. camathias.carlo@gmail.com.
2
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. camathias.carlo@gmail.com.
3
Basel Medical School, University of Basel, Petersplatz 1, 4003, Basel, Switzerland. camathias.carlo@gmail.com.
4
Basel Medical School, University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
5
Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland.
6
Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland.
7
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
8
ADUS Klinik, Breitestrasse 11, 8157, Dielsdorf, Switzerland.
9
Praxis Zeppelin, Brauerstrasse 95, 9016, St. Gallen, Switzerland.

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.

KEYWORDS:

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

PMID:
32130443
DOI:
10.1007/s00167-020-05911-y

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