Influence of patella alta on knee extensor mechanics

The purpose of this study was to compare the knee extensor mechanics in persons with and without patella alta. Thirteen subjects with patella alta and 14 subjects with normal patellar position participated in the study. Sagittal and axial MR images of the knee were acquired at 0°, 20°, 40°, and 60° of knee flexion. Measurements of actual moment arm, patellar ligament/quadriceps tendon force ratio, quadriceps effective moment arm, and joint reaction force/quadriceps force ratio were obtained. There were no differences between groups in terms of actual moment arm. However, subjects with patella alta had significantly larger patellar ligament/quadriceps tendon force ratios (1.04±0.02 vs. 0.92±0.02) and quadriceps effective moment arms (4.40±0.09 vs. 4.00±0.09 cm) when averaged across the range of knee flexion angles tested. There was no difference in the joint reaction force/quadriceps force ratio between groups. The observed differences in knee extensor mechanics suggest that individuals with patella alta have a more efficient knee extensor mechanism and would be expected to generate similar joint reaction forces per unit quadriceps force compared to subjects with normal patellar position. Therefore, persons with patella alta may experience less patellofemoral joint reaction force to overcome the same knee flexion moment in the range of 0°–60° of knee flexion.     

Orientation of tendons in vivo with active and passive knee muscles

Tendon orientations in knee models are often taken from cadaver studies. The aim of this study was to investigate the effect of muscle activation on tendon orientation in vivo. Magnetic resonance imaging (MRI) images of the knee were made during relaxation and isometric knee extensions and flexions with 0 degrees , 15 degrees and 30 degrees of knee joint flexion. For six tendons, the orientation angles in sagittal and frontal plane were calculated. In the sagittal plane, muscle activation pulled the patellar tendon to a more vertical orientation and the semitendinosus and sartorius tendons to a more posterior orientation. In the frontal plane, the semitendinosus had a less lateral orientation, the biceps femoris a more medial orientation and the patellar tendon less medial orientation in loaded compared to unloaded conditions. The knee joint angle also influenced the tendon orientations. In the sagittal plane, the patellar tendon had a more anterior orientation near full extension and the biceps femoris had an anterior orientation with 0 degrees and 15 degrees flexions and neutral with 30 degrees flexions. Within 0 degrees to 30 degrees of flexion, the biceps femoris cannot produce a posterior shear force and the anterior angle of the patellar tendon is always larger than the hamstring tendons. Therefore, co-contraction of the hamstring and quadriceps is unlikely to reduce anterior shear forces in knee angles up to 30 degrees . Finally, inter-individual variation in tendon angles was large. This suggests that the amount of shear force produced and the potential to counteract shear forces by co-contraction is subject-specific.     

Time-of-day effect on patella tendon stiffness alters vastus lateralis fascicle length but not the quadriceps force-angle relationship

AIM: To examine the time-of-day (TOD) effect on torque-force/angle, fibre length (FL), tendon stiffness (K), stress, and strain using the quadriceps muscle-tendon complex as a model. METHODS: Twelve healthy young men (aged 27+/-2.0 years) were studied at AM (7h45) and PM (5h45). Maximal isometric contractions were carried out on an isokinetic dynamometer, with real-time recordings of vastus lateralis (VL) FL and patella tendon K using B-mode ultrasonography. Percutaneous electrical twitch doublets superimposed on maximal torque were used to test for muscle activation capacity (AC). RESULTS: At PM, torque and force increased by 16+/-3.0% (P<0.01) over 30-90 degrees knee angles. Where the load was standardised (at 250N) in order to discriminate between torque generation capacity and tendon K changes, PM relative to AM, there were 8% and 13% (P<0.01) reductions in relaxed and contracted FL, respectively. Average K decreased by 21% (P<0.001) and the maximal stress and strain were increased at PM by 11% and 16%, respectively (P<0.01). No TOD effect on AC was seen. CONCLUSION: The quadriceps torque or force-angle relationships shift upwards at PM vs. AM, with no shift in the position of the optimal knee angle. This torque or force increase appears not to be centrally modulated. Although K decreases with TOD thereby potentially shortening the working length of the sarcomeres, these changes overall do not affect the ability of the muscle to produce greater torque in the evening.     

Does epimuscular myofascial force transmission occur between the human quadriceps muscles in vivo during passive stretching?

This study sought to examine the shear modulus (i.e., an force index) of three quadriceps muscles [i.e., vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF)] during passive stretching to determine whether epimuscular myofascial force transmission occurs across muscles. Secondly, this study compared the shear modulus between the quadriceps muscles, in both proximal and distal regions. Twelve healthy individuals were assessed during a passive knee flexion maneuver between 0° and 90° of knee flexion with the hip in two positions: flexed (80°) vs. neutral (0°). Muscle electrical activity was also assessed during the testing. No differences were observed between the hip testing positions for myoelectric activity (p > 0.43), and for VL and VM shear modulus (p = 0.12–0.98). Similarly, there were no differences between the proximal and distal regions for all muscles (p = 0.42–0.93). RF showed a higher shear modulus with the hip in the neutral position (p = 0.004). With the hip flexed, the VL showed the greatest shear modulus among the tested muscles (p < 0.025); while with the hip in the neutral position, no differences were observed for shear modulus between VL and RF (p = 0.817). These findings suggest that epimuscular myofascial force transmission (at a muscle belly level) does not occur between the quadriceps muscles when passively flexing the knee until 90°. Whether epimuscular myofascial force transmission occurs in the quadriceps muscles bellies with greater muscle stretch (either through knee flexion or hip extension) remains to be examined.     

Effect of resistance training on skeletal muscle-specific force in elderly humans.

This study assessed muscle-specific force in vivo following strength training in old age. Subjects were assigned to training (n = 9, age 74.3 +/- 3.5 yr; mean +/- SD) and control (n = 9, age 67.1 +/- 2 yr) groups. Leg-extension and leg-press exercises (2 sets of 10 repetitions at 80% of the 5 repetition maximum) were performed three times/wk for 14 wk. Vastus lateralis (VL) muscle fascicle force was calculated from maximal isometric voluntary knee extensor torque with superimposed stimuli, accounting for the patella tendon moment arm length, ultrasound-based measurements of muscle architecture, and antagonist cocontraction estimated from electromyographic activity. Physiological cross-sectional area (PCSA) was calculated from the ratio of muscle volume to fascicle length. Specific force was calculated by dividing fascicle force by PCSA. Fascicle force increased by 11%, from 847.9 +/- 365.3 N before to 939.3 +/- 347.8 N after training (P < 0.05). Due to a relatively greater increase in fascicle length (11%) than muscle volume (6%), PCSA remained unchanged (pretraining: 30.4 +/- 8.9 cm(2); posttraining: 29.1 +/- 8.4 cm(2); P > 0.05). Activation capacity and VL muscle root mean square electromyographic activity increased by 5 and 40%, respectively, after training (P < 0.05), indicating increased agonist neural drive, whereas antagonist cocontraction remained unchanged (P > 0.05). The VL muscle-specific force increased by 19%, from 27 +/- 6.3 N/cm(2) before to 32.1 +/- 7.4 N/cm(2) after training (P < 0.01), highlighting the effectiveness of strength training for increasing the intrinsic force-producing capacity of skeletal muscle in old age.     

Lateral force–displacement behaviour of the human patella and its variation with knee flexion — a biomechanical study in vitro

This study measured the patellar lateral force–displacement behaviour at a range of knee flexion angles in normal human cadaver specimens. The knee extensor muscles were loaded in proportion to their physiological cross-sectional areas, the tensions being applied in physiological directions along the separate quadriceps muscles. Knee extension was blocked at a range of knee flexion angles from 0 to 90°, and patellar lateral displacement versus force characteristics were measured. This experiment was repeated with three total muscle forces, 20, 175 and 350 N, which were held constant at all flexion angles. It was shown that similar stability variation was obtained with the different total muscle loads, and also the forces required to produce a range of patellar displacements (1, 5, 9 mm) were examined. A 5 mm lateral patellar displacement required a constant displacing force (i.e. the patella had constant lateral stability) up to 60° knee flexion, and then a significant increase at 90°. The results were related to surgicaland anatomical observations.     

The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL

This study investigated the effect of hamstring co-contraction with quadriceps on the kinematics of the human knee joint and the in-situ forces in the anterior cruciate ligament (ACL) during a simulated isometric extension motion of the knee. Cadaveric human knee specimens (n = 10) were tested using the robotic universal force moment sensor (UFS) system and measurements of knee kinematics and in-situ forces in the ACL were based on reference positions on the path of passive flexion/extension motion of the knee. With an isolated 200 N quadriceps load, the knee underwent anterior and lateral tibial translation as well as internal tibial rotation with respect to the femur. Both translation and rotation increased when the knee was flexed from full extension to 30 of flexion; with further flexion, these motion decreased. The addition of 80 N antagonistic hamstrings load significantly reduced both anterior and lateral tibial translation as well as internal tibial rotation at knee flexion angles tested except at full extension. At 30 of flexion, the anterior tibial translation, lateral tibial translation, and internal tibial rotation were significantly reduced by 18, 46, and 30%, respectively (p<0.05). The in-situ forces in the ACL under the quadriceps load were found to increase from 27.8+/-9.3 N at full extension to a maximum of 44.9+/-13.8 N at 15 of flexion and then decrease to 10 N beyond 60 of flexion. The in-situ force at 15 was significantly higher than that at other flexion angles (p<0.05). The addition of the hamstring load of 80 N significantly reduced the in-situ forces in the ACL at 15, 30 and 60 of flexion by 30, 43, and 44%, respectively (p<0.05). These data demonstrate that maximum knee motion may not necessarily correspond to the highest in-situ forces in the ACL. The data also suggest that hamstring co-contraction with quadriceps is effective in reducing excessive forces in the ACL particularly between 15 and 60 of knee flexion.     

Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces

Estimating tibiofemoral joint contact forces is important for understanding the initiation and progression of knee osteoarthritis. However, tibiofemoral contact force predictions are influenced by many factors including muscle forces and anatomical representations of the knee joint. This study aimed to investigate the influence of subject-specific geometry and knee joint kinematics on the prediction of tibiofemoral contact forces using a calibrated EMG-driven neuromusculoskeletal model of the knee. One participant fitted with an instrumented total knee replacement walked at a self-selected speed while medial and lateral tibiofemoral contact forces, ground reaction forces, whole-body kinematics, and lower-limb muscle activity were simultaneously measured. The combination of generic and subject-specific knee joint geometry and kinematics resulted in four different OpenSim models used to estimate muscle–tendon lengths and moment arms. The subject-specific geometric model was created from CT scans and the subject-specific knee joint kinematics representing the translation of the tibia relative to the femur was obtained from fluoroscopy. The EMG-driven model was calibrated using one walking trial, but with three different cost functions that tracked the knee flexion/extension moments with and without constraint over the estimated joint contact forces. The calibrated models then predicted the medial and lateral tibiofemoral contact forces for five other different walking trials. The use of subject-specific models with minimization of the peak tibiofemoral contact forces improved the accuracy of medial contact forces by 47% and lateral contact forces by 7%, respectively compared with the use of generic musculoskeletal model.     

Measurement of fibre pennation using ultrasound in the human quadriceps in vivo.

Real-time ultrasound scanning was used to measure the angles of fibre pennation of vastus lateralis (VL) and vastus intermedius (VI) of the human quadriceps (n = 12) in vivo. The maximum isometric force and cross-sectional area of the quadriceps were also measured. With the knee at right-angles the mean fibre angles for VL and VI respectively were 0.133 (0.021) rad [7.6 degrees (1.2 degrees)] and 0.143 (0.028) rad [8.2 degrees (1.6 degrees)] [mean (SD)], which is within the range of angles measured on cadavers. The mean angle decreased in going from the contracted [VL, 0.244 rad (14 degrees); VI, 0.279 rad (16 degrees)] to the stretched [VL, 0.105 rad (6 degrees); VI, 0.122 rad (7 degrees)] position. There was a significant positive correlation between fibre angle and muscle cross-sectional area but no relationship between fibre angle and force per cross-sectional area. No increase in fibre angle was detected after 3 months strength training. We conclude that ultrasound can be used to measure pennation angles of superficial muscle groups but we could not demonstrate a relationship between pennation and force-generating capacity.     

A mathematical model of the patellofemoral joint

A mathematical model of the patellofemoral joint taking into account movements and forces in the sagittal plane is described. The system parameters of the model are the locations of the attachments of the quadriceps muscle and the patellar ligament, the length of the patellar ligament, the dimensions of the patella and the geometry of the articulating surfaces. They were obtained from ten autopsy knees. The model enables calculation of the relative position of the patella, patellar ligament and quadriceps tendon, the location of the patellofemoral contact point and the magnitude of the patellofemoral compression force and the force in the patellar ligament as a function of the location of the tibial tuberosity at different flexion-extension angles of the knee. The model is validated by comparing model data with experimentally determined data.     

The orientation of the distal part of the quadriceps femoris muscle as a function of the knee flexion-extension angle

Lateral view radiographs of ten autopsy knees were used to determine the orientation of the patellar ligament, patella and quadriceps tendon relative to tibia and femur at different flexion-extension angles (0-120 degrees) of the knee. The results show a linear relationship between the angle of flexion and the movement of the patellar ligament relative to the tibia and of the movement of the patella relative to tibia and femur. There is a non-linear relationship between angle of flexion and the movement of the quadriceps tendon relative to the patellar ligament, patella and femur. The angular changes between patella and patellar ligament are negligible. The complicated movements of the distal part of the quadriceps femoris muscle may significantly influence biomechanical parameters such as the forces acting at the patella and tibial tuberosity.     

Comparing two estimations of the quadriceps force distribution for use during patellofemoral simulation

EMG analysis has indicated that the vastus lateralis and vastus medialis contribute less to the quadriceps moment during knee extension than the physiological cross-sectional areas (PCSA's) of the muscles indicate. Both PCSA- and EMG-based quadriceps force distributions were utilized while computationally simulating knee extension. For both distributions, a 10 degrees increase in the Q-angle and a 50% decrease in the force applied by the vastus medialis were simulated, and the influence of these changes on the resultant force and moment applied by the quadriceps muscles and the patella tendon was quantified. For both quadriceps force distributions, increasing the Q-angle increased the lateral force and the moment acting to rotate the distal patella laterally. Due to the relatively large forces initially attributed to the vastus medialis and vastus lateralis for the PCSA-based quadriceps force distribution, decreasing the vastus medialis force created a large force imbalance between these two muscles. For the PCSA-based quadriceps force distribution, decreasing the vastus medialis force increased the lateral rotation moment and the moment acting to tilt the patella laterally. For the EMG-based quadriceps force distribution, decreasing the vastus medialis force produced relatively little change in the tilt and rotation moments. For both quadriceps force distributions, increasing the Q-angle increased the maximum and mean cartilage pressure during flexion, but decreasing the vastus medialis force only increased the cartilage pressures for the PCSA-based quadriceps distribution. The choice of the initial quadriceps distribution can influence the outcome of patellofemoral simulation when manipulating quadriceps muscle forces.     

The effect of vastus medialis forces on patello-femoral contact: a model-based study

A mathematical model of the patello-femoral joint was introduced to investigate the impact of the vastus medialis (longus, obliquus) forces on the lateral contact force levels. In the model, the quadriceps were represented as five separate forces: vastus lateralis, vastus intermedius, rectus femoris, vastus medialis longus (VML), and obliquus (VMO). By varying the relative force generation ratios of the quadriceps heads, the patello-femoral contact forces were estimated. We sought to analytically determine the range of forces in the VMO and VML that cause a reduction or an increase of lateral contact forces, often the cause of patello-femoral pain. Our results indicated that increased contact forces are more dependent on combinations of muscle forces than solely VMO weakness. Moreover, our simulation data showed that the contact force levels are also highly dependent on the knee flexion angle. These findings suggest that training targeted to reduce contact forces through certain joint angles could actually result in a significant increase of the contact forces through other joint angles.     

Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist

Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics—kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°–90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.     

Patellofemoral cartilage stresses are most sensitive to variations in vastus medialis muscle forces

The purpose of this study was to evaluate the effects of variations in quadriceps muscle forces on patellofemoral stress. We created subject-specific finite element models for 21 individuals with chronic patellofemoral pain and 16 pain-free control subjects. We extracted three-dimensional geometries from high resolution magnetic resonance images and registered the geometries to magnetic resonance images from an upright weight bearing squat with the knees flexed at 60°. We estimated quadriceps muscle forces corresponding to 60° knee flexion during a stair climb task from motion analysis and electromyography-driven musculoskeletal modelling. We applied the quadriceps muscle forces to our finite element models and evaluated patellofemoral cartilage stress. We quantified cartilage stress using an energy-based effective stress, a scalar quantity representing the local stress intensity in the tissue. We used probabilistic methods to evaluate the effects of variations in quadriceps muscle forces from five trials of the stair climb task for each subject. Patellofemoral effective stress was most sensitive to variations in forces in the two branches of the vastus medialis muscle. Femur cartilage effective stress was most sensitive to variations in vastus medialis forces in 29/37 (78%) subjects, and patella cartilage effective stress was most sensitive to variations in vastus medialis forces in 21/37 (57%) subjects. Femur cartilage effective stress was more sensitive to variations in vastus medialis longus forces in subjects classified as maltrackers compared to normal tracking subjects (p?=?0.006). This study provides new evidence of the importance of the vastus medialis muscle in the treatment of patellofemoral pain.     

In vitro forces in the normal and cruciate-deficient knee during simulated squatting motion

Three orthogonal components of the tibiofemoral and patellofemoral forces were measured simultaneously for knees with intact cruciate ligaments (nine knees), following anterior cruciate ligament resection (six knees), and subsequent posterior cruciate ligament resection (six knees). The knees were loaded using an experimental protocol that modeled static double-leg squat. The mean compressive tibial force increased with flexion angle. The mean anteroposterior tibial shear force acted posteriorly on the tibia below 50 deg flexion and anteriorly above 55 deg. Mediolateral shear forces were low compared to the other force components and tended to be directed medially on both the patella and tibia. The mean value of the ratio of the resultant tibial force divided by the quadriceps force decreased with increasing flexion angle and was between 0.6 and 0.7 above 70 deg flexion. The mean value of the ratio of the resultant tibiofemoral contact force divided by the resultant patellofemoral contact force decreased with increasing flexion and was between 0.8 and 1.0 above 55 deg flexion. Cruciate ligament resection resulted in no significant changes in the patellar contact forces. Following resection of the anterior cruciate ligament, the tibial anteroposterior shear force was directed anteriorly over all flexion angles tested. Subsequent resection of the posterior cruciate ligament resulted in an approximately 10 percent increase in the quadriceps tendon and tibial compressive force.     

The effect of design variables of condylar total knees on the joint forces in step climbing based on a computer model.

The ability to climb a steep step or rise from a low chair after total knee replacement may be enhanced if the required force in the quadriceps muscle is reduced. This can potentially be achieved if the total knee produces a large lever arm measured from the femoral-tibial contact point to the patellar ligament. A reduced quadriceps force would also reduce the patello-femoral force and the femoral-tibial contact force. The contact point location is likely to be a function of the geometry of the femoral and tibial components in the sagittal plane, including the relative distal and posterior radii of the femoral profile, the location of the bottom-of-the-dish of the tibial surface, the radius of the tibial surface, and the presence or absence of the posterior cruciate ligament. A three-dimensional model of the knee was developed including the quadriceps and various ligaments. In the study, the motion was confined to flexion extension and displacement in the sagittal plane. The quadriceps was assumed to be the only muscle acting. A standard software package (Pro/Mechanica) was used for the analysis. For a femoral component with a smaller distal radius, there was 12% reduction in the quadriceps muscle force and up to 11% reduction in the patello-femoral force from about 100 up to 60 degrees flexion. However, apart from that, there were less than 10% differences in all the forces as a function of all of the design variables studied. This was attributed to the relatively small changes in the lever arm of the patella tendon, since the tendon moves in an anterior-posterior direction along with the femur. An additional factor explaining the results was the change in the anterior-posterior contact point as controlled by the forces in the patella tendon and in the soft tissues. The results imply that for a standard condylar replacement knee, the muscle and contact forces are not greatly affected by the geometrical design variables.     

Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls

One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n=27, 16 female; 11 male) and compare these to pain-free controls (n=16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p=0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30–50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (p<0.05). These results suggest that some patellofemoral pain patients might experience greater joint contact forces and joint stresses than pain-free subjects. The muscle force data are available as supplementary material.     

Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings

PurposeThe purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ).MethodsFifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping.ResultsThe peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001).ConclusionThis study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an increased medial and posterior neuromuscular activation (dominant hamstrings medialis activity) during the preparatory and initial contact phase and an increased lateral neuromuscular activation (dominant vastus lateralis activity) during the peak loading phase.     

Patellofemoral joint forces

In this review of patellofemoral joint forces as they might apply to implant design, methodologies for estimating forces on the patella and estimates of the forces, as reported in the literature, are summarized. Two methodologies exist for studying joint loads; one that measures kinematics in-vivo and uses analysis to estimate the joint loads and another that measures ground reaction forces and uses analysis to estimate the joint loads. In both these analyses many assumptions are required with varying degrees of uncertainty; here, those assumptions are examined with data from the published literature. The topics covered include: relationships between quadriceps forces and patellofemoral forces or patella ligament forces, relationships between knee joint moments and quadriceps forces, knee joint moments in various gaits, relationships between patellofemoral forces and lateral subluxation forces, and relationships between patella forces and inferior-superior forces. In many cases, there is little data on patella forces during normal activities, in other cases, there are some discrepancies in reported patella forces, i.e. during squat.