Biomechanics of the patellofemoral joint.

The patellofemoral joint contains 2 complex mechanisms for ameliorating forces transmitted across it, namely increasing extensor lever arm-r in the important range of flexion 30 degrees-70 degrees and increasing contact area with increasing flexion. In this range the patella bears sole responsibility for transmitting resultant flexion of quadriceps force to the femur. Here lies the thickest cartilage in the body and perhaps not surprisingly, the most frequent site of cartilage degeneration. The Q-angle and valgus vector explain the predominance of the pathologic lesions on the lateral side of the joint as well as the associated dislocations, subluxations, lateral pressure syndromes, and patellofemoral arthrosis. Extension exercises against resistance produce non-physiologic loading of patellar articular cartilage. Even relatively small loads which are commonly used in physical therapy departments produce pressures far in excess of normal activities, such as stair climbing or squatting. Patients who are placed on such exercise programs are often made worse and develop symptoms which they did not have before. Straight leg raising with weights, on the other hand, maximally stresses the quadriceps muscle without any patellofemoral compression since the patella is out of contact, proximal to the trochlea.