Background: Patellofemoral pain syndrome (PFPS) is one of the most frequent seen overuse injury in roadcycling, but knowledge about risk factors remains limited.

Purpose: To investigate associations between intrinsic risk factors and patellofemoral pain in roadcycling. 

Study design: Retrospective case-control study

Method: A total of 50 roadcyclists and triathletes on recreational and competitive level were assessed for Q- angle, femoral anteversion angle, back thigh flexibility and hip flexion range of motion. Furthermore, kinematics analysis in 3D was performed during anaerobe cycling test and lunges. The analysis was performed and presented per limb n=100 (PFPS group n=46, control group n=54)

Results: Kinematic analysis during the cycling test showed significant differences between groups with PFPS group presenting higher mean value in torso rotation (PFPS: 6.46°± 2.93°, C: 4.78° ± 1.77°, p=.001), torso lateral flexion (PFPS: 8.20° ± 3.43°; C: 6.85° ± 2.95°; P=.035), pelvis rotation (PFPS: 10.14° ± 3.23°, C: 7.11° ± 3.63°,p=,00), knee lateral travel related to pelvis (PFPS: 6.67° ± 3.41°, C: 5.28° ± 1.93°,p=.012). In addition, the group with PFPS had a significant more lateral projection of the knee (PFPS 9,05cm ± 1,71, C: 8,4cm ±1,44 p=,041). Pelvis inclination, knee lateral travel relative to bike, ankling and dorsal/plantarflexion or performance of lunges did not differ between groups. In the multivariate model, a retroverted femoral angle (OR, 8.28; 95% CI 2.50-27.43: p=.001), passive straight leg raise less than 70° (OR, 3.67; 95% CI, 1.05-14.30; p=.043), lateral projection of knee during cycling test (OR, 1.48; 95% CI, 1.04-2.11; p=.031) and pelvis rotation during cycling test (OR, 1.20; 95% CI 1.03-1.41: p=.020) was associated with PFPS.

Conclusion: Altered pelvis kinematics, retroverted femoral angle and decreased flexibility in back thigh is suggested as being associated with PFPS in roadcycling and further research is warranted regarding the association.

Retrospective study design and some methodological issues makes result limited for clinical implication and additional studies are recommended.

Clinical relevance: Knowledge about decreased flexibility in back tigh, femoral retroversion angle and altered pelvis kinematic beeing possible risk factors for PFPS in cyclists, enables more targeted research aiming to develop prevention strategies and adds an additional perspective in rehabilitation and performance enhancing work with road cyclists.