Influence of lower limb torque, range of motion, and foot alignment in patellar rotation (Arno angle) in athletes

Abstract

BackgroundAlterations of frontal plane patellar alignment could be related to lower limb disorders. Clinical assessment must be able to identify the influence of non-local factors in patellar alignment. ObjectiveTo identify the influence of lower limb torque, range of motion (ROM), and foot alignment on patellar rotation in healthy athletes. MethodsThis cross-sectional study was performed with 232 healthy basketball and volleyball elite athletes. Participants were assessed in preseason for: patellar medial and lateral rotation (Arno angle), passive hip internal rotation (IR) ROM, iliotibial band flexibility, hip abductors and external rotators (ER) torque, shank-forefoot alignment (SFA), and ankle dorsiflexion ROM. Hierarchical multiple linear regression was performed to identify if these variables and sex, age, and body mass could be associated with patellar rotation in a standing position. ResultsHip ER isometric torque explained a small part (10%) of the variance of the Arno angle in healthy athletes (R² change=0.10; unstandardized ß=11.74 (95% CI 6.82, 16.65); Standardized Coefficient Beta=0.32) and sex explained 2% of its variance (R² change=0.02; unstandardized ß= 2.42 (95% CI 0.32, 4.52); Standardized Coefficient Beta=0.15). After controlling for sex, hip ER torque explained 9% of Arno angle variance (R² change=0.09; unstandardized ß= 11.09 (95% CI 6.43, 15.76; Standardized Coefficient Beta=0.31). The other variables were not associated with patellar rotation. ConclusionsHip ER torque may influence patellar rotation in different directions (medial or lateral rotation). Possible mechanisms that explain the contribution of higher and lower hip ER torque in lateral and medial patellar rotation, respectively, are discussed.