The power of transverse plane limb mal-alignment in the genesis of anterior knee pain—clinical relevance

Anterior Knee Pain has been associated with multiple independent factors. The most consistent commonality is a force which exceeds the tolerance of tissues subjected to that force. The quadriceps muscle generates most of the force acting on the anterior knee. A force has magnitude and direction. The direction of the quadriceps is greatly altered by the skeletal alignment in the limb. When abnormal skeletal alignment is present, its correction has the greatest influence on altering the direction and therefore magnitude of an offending force. This can only be accomplished with osteotomy of the femur or tibia, depending on the location and type of deformity, be it torsion, varus-valgus or flexion-extension.