Analysis of Isolated Patella Fractures: Do they Affect Walking?

Abstract

Introduction

The patella is an important part of the extensor mechanism of the knee. Due to its subcutaneous location, it can be easily exposed to trauma. In this study, we aimed to clarify the effect of patella fractures on walking by examining the results of gait analysis of patients with patella fractures.

Methods

Patients who were treated due to a patella fracture in the last 10 years were selected from the hospital archive. A total of 18 patients and 36 healthy control subjects were included. Clinical, radiological, and functional results were collected for the fracture group retrospectively, and gait analysis was performed for all patients and control subjects. Results were evaluated statistically.

Results

The mean follow-up time for the fracture group was 64.9 ± 47.02 months. Foot rotation (p = 0.026), step width (SW; p < 0.001), lateral symmetry (LSIM; p < 0.001,) and anterior-posterior variability (p = 0.012) were found to be statistically increased on the injured sides of the fracture group compared to the control group.

Conclusion

In this study, it was found that patellar fractures resulted in increased foot rotation, and it was thought that this result might be related to the compensatory mechanism of knee joint arthrosis to reduce the knee adduction moment and the lateral-medial shear force. Multivariate analyses showed that LSIM and FR were associated with patella fracture. A multicenter study with a greater number of patients is needed for more accurate results.

Zusammenfassung

Einleitung

Die Patella ist ein wichtiger Bestandteil des Streckmechanismus des Knies. Aufgrund ihrer subkutanen Lage ist sie besonders anfällig für Traumata. In dieser Studie wollten wir den Einfluss von Patellafrakturen auf das Gehen klären, indem wir die Ergebnisse der Ganganalyse von Patienten mit Patellafrakturen untersuchten.

Methoden

Patienten, die in den letzten 10 Jahren aufgrund einer Patellafraktur behandelt wurden, wurden aus dem Krankenhausarchiv ermittelt. Insgesamt wurden 18 Patienten sowie 36 gesunde Kontrollpersonen eingeschlossen. Klinische, radiologische und funktionelle Ergebnisse wurden für die Frakturgruppe retrospektiv erhoben, und eine Ganganalyse wurde für alle Patienten und Kontrollpersonen durchgeführt. Die Ergebnisse wurden statistisch ausgewertet.

Ergebnisse

Die mittlere Nachbeobachtungszeit für die Frakturgruppe betrug 64,9 ± 47,02 Monate. Fußrotation (p = 0,026), Schrittweite (SW; p < 0,001), laterale Symmetrie (LSIM; p < 0,001) und anterior-posteriore Variabilität (p = 0,012) waren auf den verletzten Seiten der Frakturgruppe im Vergleich zur Kontrollgruppe statistisch erhöht.

Schlussfolgerung

Diese Studie zeigte, dass Patellafrakturen zu einer erhöhten Fußrotation führten. Es wurde vermutet, dass dies mit dem Kompensationsmechanismus der Kniegelenksarthrose zur Reduzierung des Knieadduktionsmoments und der lateral-medialen Scherkraft zusammenhängt. Multivariante Analysen zeigten, dass LSIM und FR mit Patellafrakturen assoziiert waren. Für genauere Ergebnisse ist eine multizentrische Studie mit einer höheren Patientenzahl erforderlich.

Keywords

patella fracture - gait analysis - extensor mechanism - knee - foot rotation

Schlüsselwörter

Patellafraktur - Ganganalyse - Streckmechanismus - Knie - Fußrotation

Publication History

Received: 28 January 2025

Accepted after revision: 09 May 2025

Article published online:
28 May 2025

• References

• 1 Loudon JK. BIOMECHANICS AND PATHOMECHANICS OF THE PATELLOFEMORAL JOINT. Int J Sports Phys Ther 2016; 11: 820-830
• 2 Verhulst FV, van Sambeeck JDP, Olthuis GS. et al. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc 2020; 28: 869-875
• 3 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494-502
• 4 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19: 198-207
• 5 Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury 1981; 13: 196-202
• 6 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
• 7 Porac C, Coren S. Lateral Preferences and human Behavior. New York: Springer; 1981
• 8 Wang JW, Kuo KN, Andriacchi TP. et al. The influence of walking mechanics and time on the results of proximal tibial osteotomy. J Bone Joint Surg Am 1990; 72: 905-909
• 9 Teichtahl AJ, Morris ME, Wluka AE. et al. Foot rotation--a potential target to modify the knee adduction moment. J Sci Med Sport 2006; 9: 67-71
• 10 Lynn SK, Kajaks T, Costigan PA. The effect of internal and external foot rotation on the adduction moment and lateral-medial shear force at the knee during gait. J Sci Med Sport 2008; 11: 444-451
• 11 Larsen P, Rathleff MS, Østgaard SE. et al. Patellar fractures are associated with an increased risk of total knee arthroplasty: A Matched Cohort Study of 6096 Patellar Fractures with a mean follow-up of 14.3 Years. Bone Joint J 2018; 100-B: 1477-1481
• 12 Skiadopoulos A, Moore EE, Sayles HR. et al. Step width variability as a discriminator of age-related gait changes. J Neuroeng Rehabil 2020; 17: 41
• 13 Gabell A, Nayak US. The effect of age on variability in gait. J Gerontol 1984; 39: 662-666
• 14 Kim SH, Park KN. Lateral symmetry of center of pressure during walking in patients with unilateral knee osteoarthritis. Physical Therapy Korea 2021; 28: 77-83
• 15 Kalron A, Frid L. The “butterfly diagram”: A gait marker for neurological and cerebellar impairment in people with multiple sclerosis. J Neurol Sci 2015; 358: 92-100
• 16 Porter S, Nantel J. Older adults prioritize postural stability in the anterior-posterior direction to regain balance following volitional lateral step. Gait Posture 2015; 41: 666-669
• 17 Parlak M. Institute of Health Sciences. Comparison Of Gait Analyzes Of Patients With Long term Ankylosing Spondylitis With Normal Individuals Using A Three-Dimensional Motion Analysis Method [Thesis of Doctorate]. Trakya University; 2017
• 18 Karahan M, Özcan M, Cığalı BS. Balance Evaluation and Gait Analysis After Arthroscopic Partial Meniscectomy. Indian J Orthop 2022; 56: 1199-1205
• 19 Collins SH, Kuo AD. Two independent contributions to step variability during over-ground human walking. PloS One 2013; 8: e73597
• 20 Vedel JO, Vistrup S, Larsen P. et al. Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients. Eur J Trauma Emerg Surg 2018; 44: 707-716
• 21 Harlaar J, Lankhorst GJ, Becher JG. et al. [Clinical analysis of motion using multimedia technology]. Ned Tijdschr Geneeskd 1998; 142: 1196-1202