Knee separation distance and lower extremity kinematics during a drop land: implications for clinical screening

Context:

Excessive knee valgus during dynamic tasks is thought to contribute to lower extremity overuse and traumatic injuries. Clinically, assessments of frontal-plane knee motion typically include measures of the distance between the knees during landing. However, it is not clear how this clinical assessment relates to knee-abduction angle or how it is influenced by the position of the lower extremities in the transverse and frontal planes.

Objective:

To determine whether normalized knee separation distance (NKSD) is a predictor of knee-abduction angles and to assess the influence of lower extremity transverse-plane and frontal-plane angles on NKSD during a drop land.

Design:

Cross-sectional study.

Setting:

Motion analysis laboratory.

Patients or Other Participants:

Twenty-five healthy female athletes.

Intervention(s):

The frontal-plane distance between the 2- dimensional coordinates of markers over the greater trochanters (intertrochanteric distance), lateral femoral epicondyles (knee separation distance), and lateral malleoli (stance width) bilaterally was calculated during a drop land. The knee separation distance was normalized by intertrochanteric distance (NKSD). Concurrently, 3-dimensional lower extremity transverse-plane and frontal-plane kinematics were obtained.

Main Outcome Measure(s):

We assessed NKSD, stance width, and bilateral average knee and hip transverse plane and frontal-plane angles and ankle frontal-plane angles. Linear regression was used to determine the association between NKSD and bilateral average knee frontal-plane angles. Stepwise multiple regression was used to identify the best predictors of NKSD during the drop land.

Results:

After we controlled for stance width, NKSD explained 52% of the variance in the knee frontal-plane angle. When we took lower extremity kinematics into account, after controlling for stance width, the average hip frontal-plane angle was the best predictor of NKSD, explaining 97% of the variance.

Conclusions:

Although NKSD is a predictor of knee- abduction angle, frontal-plane hip angle and stance width are strongly related to NKSD. Caution must be taken when interpreting NKSD as knee abduction.