Effects of simulated vastus medialis strength variation on patellofemoral joint biomechanics in human cadaver knees

Selective strengthening of the vastus medialis (VM) muscle is a conservative treatment used to address some patellofemoral joint (PFJ) problems. The objective of this study was to examine the effects of varying VM strength on PFJ kinematics and contact pressures and areas. We tested five fresh-frozen cadaveric knees using a custom knee jig, which permits the simulation of physiologic quadriceps loading while also allowing the VM force to be varied. PFJ kinematics were measured with a magnetic tracking device. PFJ contact pressures and areas were measured with Fuji pressure-sensitive film. For PFJ kinematics, the change in the medial-lateral and superior-inferior translation was significant at 0% of VM strength and 150% of VM strength with respect to the 100% of VM strength condition (p < 0.05). Extreme changes in the VM force had a statistically significant effect on patellofemoral contact pressures (0% of VM strength (19 +/- 10%) and 150% of VM strength (17 +/- 3%) with respect to 100% of VM strength condition (p < 0.05)). No statistically significant differences were shown in the patellofemoral contact areas (p > 0.05). The functional range of VM strength is between 75% and 125% of total VM strength. The PFJ kinematics and contact pressures were not significantly influenced by VM strength except at extreme conditions (0% of VM strength or 150% of VM strength) in human cadaveric knees.