American Journal of Roentgenology, Vol 161, 617-620, Copyright © 1993 by American Roentgen Ray Society
Motion of the patella during walking: a video digital-fluoroscopic study in healthy volunteers
LA Stein, AN Endicott, JS Sampalis, MA Kaplow, MD Patel and NS Mitchell
Department of Radiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
OBJECTIVE. The alignment of the quadriceps muscle and patella suggests that
the patella should deviate laterally out of the patellar groove as the
quadriceps muscle contracts during walking. The surgical treatment of
patellar subluxation has been based on this presumption. The purpose of
this study was to determine the movements of the patella in relation to the
other bones of the knee joint during normal walking. This is the first
study we know of that uses radiographs to show these movements. SUBJECTS
AND METHODS. Eight healthy adult volunteers with no previous complaints
referable to the knee walked on a slowly moving treadmill while their
patellae were imaged fluoroscopically in the anteroposterior plane with a
Toshiba C-arm. Images were retrieved, transferred to radiographic film, and
randomized to prevent the observers from knowing the order of images. The
position of the patella was measured and plotted in relation to fixed
points of the knee. RESULTS. In each of the subjects at every gait cycle,
the patella was observed to move vertically first, followed by a sudden
shift to the medial side before returning to its original position.
CONCLUSION. Contrary to conventional understanding, our results show that
the patella deviates medially rather than laterally during walking. This
occurs because of differential contraction of the components of the
quadriceps muscle during walking. The management of painful and subluxated
patellae must be reevaluated in light of this finding.
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