A predictive model to estimate knee-abduction moment

Implications for development of a clinically applicable patellofemoral pain screening tool in female athletes

Gregory D. Myer, Kevin R. Ford, Kim D Barber Foss, Mitchell J. Rauh, Mark V. Paterno, Timothy Hewett

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Context: Prospective measures of high external kneeabduction moment (KAM) during landing identify female athletes at increased risk of patellofemoral pain (PFP). A clinically applicable screening protocol is needed. Objective: To identify biomechanical laboratory measures that would accurately quantify KAM loads during landing that predict increased risk of PFP in female athletes and clinical correlates to laboratory-based measures of increased KAM status for use in a clinical PFP injury-risk prediction algorithm. We hypothesized that we could identify clinical correlates that combine to accurately determine increased KAM associated with an increased risk of developing PFP. Design: Descriptive laboratory study. Setting: Biomechanical laboratory. Patients or Other Participants: Adolescent female basketball and soccer players (n = 698) from a single-county public school district. Main Outcome Measure(s): We conducted tests of anthropometrics, maturation, laxity, flexibility, strength, and landing biomechanics before each competitive season. Pearson correlation and linear and logistic regression modeling were used to examine high KAM (>15.4 Nm) compared with normal KAM as a surrogate for PFP injury risk. Results: The multivariable logistic regression model that used the variables peak knee-abduction angle, center-of-mass height, and hip rotational moment excursion predicted KAM associated with PFP risk (>15.4 NM of KAM) with 92% sensitivity and 74% specificity and a C statistic of 0.93. The multivariate linear regression model that included the same predictors accounted for 70% of the variance in KAM. We identified clinical correlates to laboratory measures that combined to predict high KAM with 92% sensitivity and 47% specificity. The clinical prediction algorithm, including knee-valgus motion (odds ratio [OR]=1.46, 95% confidence interval [CI]=1.31, 1.63), center-ofmass height (OR = 1.21, 95% CI = 1.15, 1.26), and hamstrings strength/body fat percentage (OR = 1.80, 95% CI = 1.02, 3.16) predicted high KAM with a C statistic of 0.80. Conclusions: Clinical correlates to laboratory-measured biomechanics associated with an increased risk of PFP yielded a highly sensitive model to predict increased KAM status. This screening algorithm consisting of a standard camcorder, physician scale for mass, and handheld dynamometer may be used to identify athletes at increased risk of PFP.

Original languageEnglish (US)
Pages (from-to)389-398
Number of pages10
JournalJournal of Athletic Training
Volume49
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Athletes
Knee
Pain
Linear Models
Logistic Models
Odds Ratio
Confidence Intervals
Biomechanical Phenomena
Basketball
Sensitivity and Specificity
Soccer
Wounds and Injuries
Adipose Tissue
Hip
Outcome Assessment (Health Care)
Physicians

Keywords

  • Assessment tools
  • High-risk biomechanics
  • Knee injury prevention
  • Patellofemoral risk factors
  • Targeted neuromuscular training

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

A predictive model to estimate knee-abduction moment : Implications for development of a clinically applicable patellofemoral pain screening tool in female athletes. / Myer, Gregory D.; Ford, Kevin R.; Foss, Kim D Barber; Rauh, Mitchell J.; Paterno, Mark V.; Hewett, Timothy.

In: Journal of Athletic Training, Vol. 49, No. 3, 2014, p. 389-398.

Research output: Contribution to journalArticle

Myer, Gregory D. ; Ford, Kevin R. ; Foss, Kim D Barber ; Rauh, Mitchell J. ; Paterno, Mark V. ; Hewett, Timothy. / A predictive model to estimate knee-abduction moment : Implications for development of a clinically applicable patellofemoral pain screening tool in female athletes. In: Journal of Athletic Training. 2014 ; Vol. 49, No. 3. pp. 389-398.
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N2 - Context: Prospective measures of high external kneeabduction moment (KAM) during landing identify female athletes at increased risk of patellofemoral pain (PFP). A clinically applicable screening protocol is needed. Objective: To identify biomechanical laboratory measures that would accurately quantify KAM loads during landing that predict increased risk of PFP in female athletes and clinical correlates to laboratory-based measures of increased KAM status for use in a clinical PFP injury-risk prediction algorithm. We hypothesized that we could identify clinical correlates that combine to accurately determine increased KAM associated with an increased risk of developing PFP. Design: Descriptive laboratory study. Setting: Biomechanical laboratory. Patients or Other Participants: Adolescent female basketball and soccer players (n = 698) from a single-county public school district. Main Outcome Measure(s): We conducted tests of anthropometrics, maturation, laxity, flexibility, strength, and landing biomechanics before each competitive season. Pearson correlation and linear and logistic regression modeling were used to examine high KAM (>15.4 Nm) compared with normal KAM as a surrogate for PFP injury risk. Results: The multivariable logistic regression model that used the variables peak knee-abduction angle, center-of-mass height, and hip rotational moment excursion predicted KAM associated with PFP risk (>15.4 NM of KAM) with 92% sensitivity and 74% specificity and a C statistic of 0.93. The multivariate linear regression model that included the same predictors accounted for 70% of the variance in KAM. We identified clinical correlates to laboratory measures that combined to predict high KAM with 92% sensitivity and 47% specificity. The clinical prediction algorithm, including knee-valgus motion (odds ratio [OR]=1.46, 95% confidence interval [CI]=1.31, 1.63), center-ofmass height (OR = 1.21, 95% CI = 1.15, 1.26), and hamstrings strength/body fat percentage (OR = 1.80, 95% CI = 1.02, 3.16) predicted high KAM with a C statistic of 0.80. Conclusions: Clinical correlates to laboratory-measured biomechanics associated with an increased risk of PFP yielded a highly sensitive model to predict increased KAM status. This screening algorithm consisting of a standard camcorder, physician scale for mass, and handheld dynamometer may be used to identify athletes at increased risk of PFP.

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