Frontal Plane Proximal and Distal Kinematics; The Relationship with Knee Valgus During Athletic Tasks.

Joyce, Victoria

Abstract

Background: Knee injuries such as Patellofemoral pain (PFP) and Anterior Cruciate
Ligament (ACL) damage are two of the most prevalent in the active population. The
aetiology of knee injuries is deemed multifactorial. Dynamic Knee valgus (DKV)
demonstrates the involvement of proximal and distal, which alter biomechanics and may
contribute to alignment disruption of lower limb kinematics during athletic tasks.
Theoretically, increasing proximal and distal variables has been suggested to contribute to
defects that may lead to knee injuries and osteoarthritis in later life. This study aims to
contribute to the clinical reasoning around DKV in asymptomatic individuals and identify
relationships with detrimental knee kinematic previously predictive and proximal and
distal kinematics. Many studies have identified knee valgus as contributing to knee
injuries. However, the research from a proximal and distal perspective is conflicting. No
current research provides data on asymptomatic frontal plan kinematics in SLL and tasks
running, exposing mean peak hip, knee, and ankle angles.
Objective: This study investigated frontal plane peak kinematics of healthy populations'
hip, knee, and ankle joints during segmented phases of 100% loading in running tasks and
a single-leg landing (SLL). To investigate the relationship of peak frontal plane angles of
the hip (proximal) joint kinematics with knee kinematics foot (distal) joint kinematics with
knee kinematics during two tasks: Run and SLL. The analysis focused on angle variations
and potential correlations between proximal (hip) and distal (ankle) kinematics at specific
movement phases. To cluster individuals who presented with combined kinematics 7
Deemed to be a potential risk which could contribute to knee injury. Which may be further
deemed to be classed as hip kinematics-driven or foot kinematic-driven individuals.
Method: Fontal Plane Kinematic 3D data extracted from fifty healthy and asymptomatic
participants (Mean±SD data: Age 26.9±5.3years, Height 166.1±24.8cm, Mass
69.6±11.7Kg) was collected and analysed. The mean peak values of the proximal
kinematics (hip), distal kinematics (ankle), and valgus were extrapolated for analysis.
Furthermore, each task with 100% loading was subdivided for both tasl onto early stance
(0-33%), middle stance (34-67%) and late stance (68-100%), respectively. Stytical
analyses were carried out using coefficient correlations, a logistic regression model, and a
novel approach to a clustering graph.
Results: The results observed for the SLL land task identified a relationship in all phases
from both a proximal and distal perspective, apart from an early stance with a weak
negative correlation (r=-0.293), with a significant difference in the 15 participants and 7
participants in the middle phases. The researcher observed no relationships in the late
phase of SLL. Hip adduction and knee valgus had a strong positive correlation (r=-.957**)
with a significance (p=0.003). The outcome of a linear logistical regression model analysis
indicated a significant difference (p=0.03) between the hip and knee maximum angles only
during the early phase of the SLL task. No significance was found during the middle and
late phases. Furthermore, no significance was observed in the distal predictability of knee
kinematics. Peak knee kinematics greater than 8° were exposed using a clustering method.
The researcher observed 50 participants' peak hip and knee mean angles for the SLL task,
resulting in 24% peak hip and knee means being grouped and 28% knee and ankle angles being grouped. In the running task in the early phase, the
proximal peak mean angles of hip adduction and knee valgus correlations indicate a weak
negative correlation (r=-0.43) with a significant difference (p=0.002). Distal peak mean
angles ankle eversion and knee valgus correlations indicate no correlation (r=.006) and
significance (p=0.02). Furthermore, the angles defined ≥6 to ≤7.9 with a peak mean angle
knee valgus were 7.2° ± 0.8, hip adduction was 11.4° ± 5.0, and ankle eversion was 6.1° ±
4.4. Hip adduction and knee valgus kinematics indicated a strong negative correlation
(r=-0.98) and significance (p=0.02). The research in distal kinematics observed no
relationships. Fifteen participants with peak angles more significant than 8° Hip adduction
and knee valgus indicated a moderate negative correlation (r=-0.74) and a significance
(p=0.002). No significance was found in ank;e kinematics. The Middel stance identified
only hip adduction and knee valgus correlations, indicating a weak negative correlation
(r=-0.32) with a significance (p=0.02) only. The late phase of Proximal peak mean angles
of hip adduction and knee valgus correlations indicate a weak negative correlation
(r=-0.26) with a significant difference (p=0.07) only. From a proximal perspective, hip
kinematics identifies a negative moderate correlation (r=-0.41) and a significant difference
(p=0.00) predictor for knee kinematics in the Run task only.
Conclusion: Peak hip angles significantly influence peak mean knee angles in both run
and SLL tasks in early to midstance. The findings suggest that the cohort of asymptomatic
participants' lower limb frontal plane kinematics in athletic tasks differ. The novel approach
to subgroup clustering of the individual's peak proximal and knee kinematics and distal
kinematic and knee kinematics data may identify individuals with a greater risk of
knee injury such as ACL or PFP.

Interpretations: The clinical identification of individual risk factors contributing to knee
injuries is warranted. The clustering of biomechanical data during loading in tasks linked
to injuries such as ACL injuries and PFP contribute to the evidence of the multifaceted
risk. The novel approach of identifying individual kinematics driven from the proximal
perspective or individual kinematics driven from the distal loading perspective needs
further investigation. This novel approach may enable the clinician to target treatment
programs for the segments influencing their detrimental knee valgus.

Citation

Joyce, V. (2024). Frontal Plane Proximal and Distal Kinematics; The Relationship with Knee Valgus During Athletic Tasks. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Mar 28, 2024
• Publicly Available Date: Apr 26, 2026
• Award Date: Apr 25, 2024