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Anterior knee pain from the evolutionary perspective.

A Paul Monk1, Harinderjit S Gill2, C L Max H Gibbons1

  • 1Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, United Kingdom.

The Knee
|June 7, 2021
PubMed
Summary

Evolutionary changes in the patellofemoral joint (PFJ) show how bipedalism altered knee structure. These ancestral adaptations may explain modern knee pain and instability, highlighting the PFJ

Keywords:
AnatomyAnterior knee painEvolutionPatellofemoral jointTrochlear

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Area of Science:

  • Paleoanthropology
  • Biomechanics
  • Evolutionary Biology

Background:

  • Investigates the evolutionary trajectory of the patellofemoral joint (PFJ) over 340 million years.
  • Examines morphological and orientational changes in the PFJ across ancestral species.

Purpose of the Study:

  • To describe the evolutionary changes in the patellofemoral joint (PFJ) morphology and orientation.
  • To correlate these changes with gait strategies and evolutionary periods.

Main Methods:

  • Utilized CT scanning of 37 specimens from the Devonian period to the present.
  • Generated 3D geometries and performed anatomical measurements from standardized bony landmarks.

Main Results:

  • Upright bipedalism dramatically altered PFJ loading, leading to significant arrangement changes.
  • Ancestral quadrupeds had broad knees with shallow trochlea; bipedal species evolved more rounded knees with lateral PFJ placement.
  • Trochlea groove depth increased from the Miocene apes to modern humans, with associated changes in sulcus angles.

Conclusions:

  • Evolving bipedal gait resulted in anterior PFJ, flattened trochlea, and a lateral arrangement prone to dislocation.
  • Understanding ancestral PFJ adaptations may clarify diverse presentations of anterior knee pain and patellofemoral instability.