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Association Between Multi-positional Hip Range of Motion and Anterior Knee Pain in Military Trainees: A
Capt Sung Min Suk1,2, Seok-Ju Yoo2, Capt Kyu Tae Kim3
1Department of Orthopedic Surgery, Republic of Korea Air Force 10th Fighter Wing, Suwon, Gyeonggi-do 16490, Republic of Korea.
Introduction:
Anterior knee pain (AKP) is a prevalent musculoskeletal complaint among military recruits, frequently disrupting basic military training. Although altered hip kinematics are suspected contributors, comprehensive clinical evaluations are limited. This study aimed to investigate the association between comprehensive multi-positional hip range of motion (ROM) and AKP in Republic of Korea (ROK) Air Force trainees.
Materials And Methods:
A cross-sectional comparative study was conducted from August 2024 to March 2025. An initial study population of 107 trainees was screened, and 104 trainees were ultimately enrolled (67 with AKP and 37 healthy controls). Hip ROM was measured in both supine and prone positions, incorporating various degrees of flexion, internal/external rotation, adduction, and abduction. Inter-group comparisons between the AKP and control groups were performed. Additionally, an intra-group paired analysis comparing the affected and unaffected limbs was conducted in 48 patients with unilateral AKP to control for individual congenital baseline variations.
Results:
There were no significant demographic differences between the groups. In the inter-group analysis, the AKP group exhibited significantly decreased supine internal rotation (SIR) and flexion-adduction-internal rotation (FAIR) compared to controls (P = .038 and P = .029, respectively). In the intra-group paired analysis of unilateral patients, the affected limbs demonstrated consistent and significant deficits in internal rotation across multiple positions, including SIR (P = .013), FAIR (P = .011), flexion-abduction-internal rotation (FAbIR) (P = .035), prone internal rotation (PIR) (P = .042), and adduction (Add) (P = .029), compared to the unaffected limbs. The most common site of AKP was the infrapatellar region (47.8% overall involvement).
Conclusions:
Consistent hip internal rotation and adduction deficits are significantly associated with AKP in military trainees. Our findings suggest that localized capsular and myofascial stiffness of the posterolateral hip complex likely impairs the hip's capacity to absorb transverse plane torques, supporting our proposed "mechanical overload" hypothesis at the infrapatellar region. Clinical screening and rehabilitation protocols for military recruits should prioritize the assessment and restoration of multi-positional hip mobility.