The effects of pediatric obesity on patellofemoral joint contact force during walking

Abstract

BackgroundObesity increases a child’s risk of developing knee pain across the lifespan, potentially through elevated patellofemoral joint loads that occur during habitual weight-bearing activities. Research questionDo obese children have greater absolute and patellar-area-normalized patellofemoral joint forces compared to healthy weight children during walking? MethodsWe utilized a cross-sectional design to address the aims of this study. Experimental biomechanics data were collected during treadmill walking in 10 healthy-weight and 10 obese 8–12 year-olds. We used radiographic images to develop subject-specific musculoskeletal models, generated walking simulations from the experimental data, and predicted patellofemoral joint contact force using established techniques. ResultsWe found that the obese children had 1.98 times greater absolute (p = 0.002) and 1.81 times greater patellar-area-normalized (p = 0.008) patellofemoral joint contact forces compared to the healthy-weight children. We observed a stronger relationship between absolute patellofemoral joint contact force and BMI (r2=0.58) than between patellofemoral joint contact force and body fat percentage (r2=0.38). SignificanceOur results indicate that obese children walk with increased patellofemoral loads in absolute terms and also relative to the area of the articulating surfaces, which likely contributes to the increased risk of knee pain in this pediatric population. This information, which provides a baseline comparison for future longitudinal studies, also informs the type and frequency of physical activity prescription aimed at reducing the risk of knee injury and improving long-term outcomes.