Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures

Abstract

Background: Clinical assessment of lower limb kinematics during dynamic tasks may identify individuals who demonstrate abnormal movement patterns that may lead to etiology of exacerbation of knee conditions such as patellofemoral joint (PFJt) pain.

Purpose: The purpose of this study was to determine the reliability, validity and associated measurement error of a clinically appropriate two-dimensional (2-D) procedure of quantifying frontal plane knee alignment during single limb squats.

Methods: Nine female and nine male recreationally active subjects with no history of PFJt pain had frontal plane limb alignment assessed using three-dimensional (3-D) motion analysis and digital video cameras (2-D analysis) while performing single limb squats. The association between 2-D and 3-D measures was quantified using Pearson's product correlation coefficients. Intraclass correlation coefficients (ICCs) were determined for within- and between-session reliability of 2-D data and standard error of measurement (SEM) was used to establish measurement error.

Results: Frontal plane limb alignment assessed with 2-D analysis demonstrated good correlation compared with 3-D methods (r = 0.64 to 0.78, p < 0.001). Within-session (0.86) and between-session ICCs (0.74) demonstrated good reliability for 2-D measures and SEM scores ranged from 2° to 4°.

Conclusion: 2-D measures have good consistency and may provide a valid measure of lower limb alignment when compared to existing 3-D methods.

Clinical relevance: Assessment of lower limb kinematics using 2-D methods may be an accurate and clinically useful alternative to 3-D motion analysis when identifying individuals who demonstrate abnormal movement patterns associated with PFJt pain.

Level of evidence: 2b.

Keywords: Patellofemoral joint pain; dynamic knee valgus; functional tasks.

Figure 1.

Frontal plane projection angle (FPPA) during a single limb squat.

Figure 2.

Scatterplot illustrating association between frontal plane knee alignment (FPPA) assessed using 2‐D (x‐axis) and 3‐D methods (y‐axis) during single limb squats at 60° of knee flexion.

Figure 3.

Bland‐Altman plot demonstrating agreement between methods. The solid horizontal line represents the mean differences, and dashed lines the 95% limits of agreement.