The effects of tibial rotation on patellar position

The effects of external and internal tibial rotation on patellar motion were investigated using a magnetic 3Space^® tracker system (Polhemus, Colchester, VT 05446, USA). Seven fresh-frozen adult cadaver knees were used in this study. The muscle alignment of each quadriceps muscle was measured to determine the direction of loading forces. Three loading patterns were used to simulate the unresisted knee extension during sitting, standing from squatting and the stance phase of walking, with different weights applied to each quadriceps muscle at each knee flexion angle. The position of the patella, along with patellar shift, tilt and rotation was measured and compared to external or internal tibial rotation and neutral rotation. In the sitting and squatting simulations the patella showed at the terminal extension of the knee more lateral shift and a more lateral tilt with tibial external rotation than in a neutral position (P < 0.05). In walking simulation, the patella showed more external rotation with external rotation of the tibia than with a neutral one, at the 0, 72 and 90% of the stance phase of walking (P < 0.05). These results demonstrate the importance of external tibial rotation as a factor in the development of patellar dislocations or subluxations, especially in athletes.