Hubungan Morfologi dan Kekuatan Otot Quadriceps Femoris dengan Patellofemoral Pain Syndrome pada Olahragawan

Ni Putu Diah Asyana Putri; I Putu Gde Surya Adhitya; I Gede Eka Juli Prasana; Govinda Vittala

doi:10.31004/koloni.v5i2.897

Authors

Ni Putu Diah Asyana Putri Universitas Udayana
I Putu Gde Surya Adhitya Universitas Udayana
I Gede Eka Juli Prasana Universitas Udayana
Govinda Vittala Universitas Udayana

DOI:

https://doi.org/10.31004/koloni.v5i2.897

Keywords:

VMO morphology, quadriceps femoris strength, patellofemoral pain syndrome, athletes.

Abstract

Patellofemoral Pain Syndrome is a clinical condition characterized by anterior knee pain that commonly occurs in athletes. The development of PFPS is multifactorial, one of which is weakness of the quadriceps femoris muscle. Specifically, atrophy of the vastus medialis oblique (VMO) muscle may also contribute to knee instability, which is associated with a greater risk of sports-related injuries. This study aimed to determine the relationship between quadriceps femoris muscle morphology, muscle strength, and PFPS in athletes. This study employed a cross-sectional design involving 74 athletes aged 16–22 years selected through purposive sampling. Muscle morphology was assessed by measuring the cross-sectional area (CSA) of the VMO using musculoskeletal ultrasonography. Muscle strength was measured using a hand-held dynamometer, while PFPS was identified using the Kujala Questionnaire. Statistical analysis was performed using Spearman’s rho bivariate test.The results demonstrated a significant positive correlation between VMO CSA morphology and Kujala scores (r = 0.24; p = 0.040), as well as between VMO CSA morphology and quadriceps femoris muscle strength (r = 0.30; p = 0.011). However, no significant correlation was found between quadriceps femoris muscle strength and Kujala scores (r = 0.22; p = 0.061). The morphology of the VMO muscle was significantly associated with the incidence of PFPS and quadriceps femoris muscle strength in athletes. These findings support the use of VMO CSA symmetry monitoring as part of early PFPS risk screening and emphasize the importance of a multisegmental approach in PFPS prevention programs for athletes.

References

Alsaleh, S. A., Murphy, N. A., Miller, S. C., Morrissey, D., & Lack, S. D. (2021). Local Neuromuscular Characteristics Associated With Patellofemoral Pain: A Systematic Review And Meta-Analysis. In Clinical Biomechanics (Vol. 90). Elsevier Ltd. Https://Doi.Org/10.1016/J.Clinbiomech.2021.105509

Beit Ner, E., Rabau, O., Essa, A., Vinograd, O., Asaaf, R., Gilat, R., & Anekstein, Y. (2025). Evaluating The Association Between Vastus Medialis Oblique Characteristics And Patellar Instability: A Comprehensive Case-Control Study. Sports Health: A Multidisciplinary Approach, 17(5), 1044–1052. Https://Doi.Org/10.1177/19417381241300159

Bessette, M., & Saluan, P. (2016). Patellofemoral Pain And Instability In Adolescent Athletes. Sports Med Arthrosc Rev, 24(4), 144–149. Www.Sportsmedarthro.Com

Bump, J. M., & Lewis, L. (2023). Patellofemoral Syndrome. Statpearls [Internet]. Https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk557657/

Castanov, V., Hassan, S. A., Shakeri, S., Vienneau, M., Zabjek, K., Richardson, D., Mckee, N. H., & Agur, A. M. R. (2019). Muscle Architecture Of Vastus Medialis Obliquus And Longus And Its Functional Implications: A Three‐Dimensional Investigation. Clinical Anatomy, 32(4), 515–523. Https://Doi.Org/10.1002/Ca.23344

David Y. Gaitonde, M., Alex Ericksen, M., & Rachel C. Robbins, M. (2019). Patellofemoral Pain Syndrome. American Family Physician, Volume 99.

Dong, C., Li, M., Hao, K., Zhao, C., Piao, K., Lin, W., Fan, C., Niu, Y., & Fei, W. (2021). Does Atrophy Of Vastus Medialis Obliquus And Vastus Lateralis Exist In Patients With Patellofemoral Pain Syndrome. Journal Of Orthopaedic Surgery And Research, 16(1). Https://Doi.Org/10.1186/S13018-021-02251-6

El Sawy, M. M., El Mikkawy, D. M. E., El-Sayed, S. M., & Desouky, A. M. (2021). Morphometric Analysis Of Vastus Medialis Oblique Muscle And Its Influence On Anterior Knee Pain. Anatomy And Cell Biology, 54(1), 1–9. Https://Doi.Org/10.5115/Acb.20.258

El-Ansary, D., Marshall, C. J., Farragher, J., Annoni, R., Schwank, A., Mcfarlane, J., Bryant, A., Han, J., Webster, M., Zito, G., Parry, S., & Pranata, A. (2021). Architectural Anatomy Of The Quadriceps And The Relationship With Muscle Strength: An Observational Study Utilising Real-Time Ultrasound In Healthy Adults. Journal Of Anatomy, 239(4), 847–855. Https://Doi.Org/10.1111/Joa.13497

Franchi, M. V., Fitze, D. P., Hanimann, J., Sarto, F., & Spörri, J. (2020). Panoramic Ultrasound Vs. Mri For The Assessment Of Hamstrings Cross-Sectional Area And Volume In A Large Athletic Cohort. Scientific Reports, 10(1). Https://Doi.Org/10.1038/S41598-020-71123-6

Franchi, M. V., Reeves, N. D., & Narici, M. V. (2017). Skeletal Muscle Remodeling In Response To Eccentric Vs. Concentric Loading: Morphological, Molecular, And Metabolic Adaptations. In Frontiers In Physiology (Vol. 8, Number Jul). Frontiers Media S.A. Https://Doi.Org/10.3389/Fphys.2017.00447

Halabchi, F., Abolhasani, M., Mirshahi, M., & Alizadeh, Z. (2017). Patellofemoral Pain In Athletes: Clinical Perspectives. Open Access Journal Of Sports Medicine, Volume 8, 189–203. Https://Doi.Org/10.2147/Oajsm.S127359

He, M., Shi, H., Fu, S., & Liu, H. (2025). Differences In Quadriceps But Not Hamstrings Strength In Runners With Varying Durations Of Patellofemoral Pain. Frontiers In Sports And Active Living, 7. Https://Doi.Org/10.3389/Fspor.2025.1612257

Holmes, C. J., Abelleyra Lastoria, D. A., Roberts, T., Ejindu, V., Robertson, C., & Hing, C. (2025). Assessing The Correlation Between Vastus Medialis Obliquus Cross-Sectional Area And Patellofemoral Instability: A Comparative Magnetic Resonance Imaging Study. Archives Of Orthopaedic And Trauma Surgery, 145(1), 448. Https://Doi.Org/10.1007/S00402-025-06059-5

Hosseini, S. H., & Farahmand, F. (2024). Is It Truly Impossible To Strengthen The Vastus Medialis In Isolation From The Entire Quadriceps Muscle Group? Heliyon, 10(24), E41012. Https://Doi.Org/10.1016/J.Heliyon.2024.E41012

Hunnicutt, J. L., Mcleod, M. M., Slone, H. S., & Gregory, C. M. (2020). Quadriceps Neuromuscular And Physical Function After Anterior Cruciate Ligament Reconstruction. Journal Of Athletic Training, 55(3), 238–245. Https://Doi.Org/10.4085/1062-6050-516-18

Jan, M. H., Lin, D. H., Lin, J. J., Lin, C. H. J., Cheng, C. K., & Lin, Y. F. (2009). Differences In Sonographic Characteristics Of The Vastus Medialis Obliquus Between Patients With Patellofemoral Pain Syndrome And Healthy Adults. American Journal Of Sports Medicine, 37(9), 1743–1749. Https://Doi.Org/10.1177/0363546509333483

Kim, S., Zuk, E. F., Distefano, L. J., Briani, R. V., & Glaviano, N. R. (2024). Lower Extremity Strength Has Weak Or No Associations With Clinical Outcomes In Individuals With Patellofemoral Pain: A Systematic Review With Evidence Gap Map And Meta-Analysis. Jospt Open, 2(3), 179–193. Https://Doi.Org/10.2519/Josptopen.2024.1137

Kujala, U. M., Jaakkola, L. H., Koskinen, S. K., Taimela, S., Hurme, M., & Nelimarkka, O. (1993). Scoring Of Patellofemoral Disorders. Arthroscopy: The Journal Of Arthroscopic & Related Surgery, 9(2), 159–163. Https://Doi.Org/10.1016/S0749-8063(05)80366-4

Lanferdini, F. J., Diefenthaeler, F., Ávila, A. G., Moro, A. R. P., Van Der Zwaard, S., & Vaz, M. A. (2023). Quadriceps Muscle Morphology Is An Important Determinant Of Maximal Isometric And Crank Torques Of Cyclists. Sports, 11(2). Https://Doi.Org/10.3390/Sports11020022

Lobo Júnior, P., Barbosa Neto, I. A., Borges, J. H. D. S., Tobias, R. F., Boitrago, M. V. D. S., & Oliveira, M. D. P. (2018). Clinical Muscular Evaluation In Patellofemoral Pain Syndrome. Acta Ortopédica Brasileira, 26(2), 91–93. Https://Doi.Org/10.1590/1413-785220182602187215

Moros, I., Boutsikari, E. C., Plakoutsis, G., Paraskevopoulos, E., Koumantakis, G. A., & Papandreou, M. (2025). Reliability And Validity Measures Of The Patellofemoral Subscale Koos-Pf In Greek Patients With Patellofemoral Pain. Journal Of Functional Morphology And Kinesiology, 10(1). Https://Doi.Org/10.3390/Jfmk10010044

Norte, G., Rush, J., & Sherman, D. (2022). Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, And Theory For Treating The Unseen In Clinical Rehabilitation. Journal Of Sport Rehabilitation, 31(6), 717–735. Https://Doi.Org/10.1123/Jsr.2021-0139

Pan, H., Fu, S., Zhou, Y., Li, H., & Shi, H. (2026). Relationship Between Quadriceps Strength Performance And Knee Joint Function During Single-Leg Hop Test In Runners With Patellofemoral Pain. Physical Therapy In Sport, 77, 37–43. Https://Doi.Org/10.1016/J.Ptsp.2025.11.009

Pattyn, E., Verdonk, P., Steyaert, A., Vanden Bossche, L., Van Den Broecke, W., Thijs, Y., & Witvrouw, E. (2011). Vastus Medialis Obliquus Atrophy: Does It Exist In Patellofemoral Pain Syndrome? American Journal Of Sports Medicine, 39(7), 1450–1455. Https://Doi.Org/10.1177/0363546511401183

Pompeo, K. D., Da Rocha, E. S., Melo, M. A., De Oliveira, N. T., Oliveira, D. F., Sonda, F. C., Dos Santos, P. F., Rodrigues, R., & Vaz, M. A. (2021). Proximal, Local, And Distal Muscle Morphology In Women With Patellofemoral Pain. Journal Of Diagnostic Medical Sonography, 37(2), 120–131. Https://Doi.Org/10.1177/8756479320972097

Ruhdorfer, A. S., Dannhauer, T., Wirth, W., Cotofana, S., Roemer, F., Nevitt, M., & Eckstein, F. (2014). Thigh Muscle Cross-Sectional Areas And Strength In Knees With Early Vs Knees Without Radiographic Knee Osteoarthritis: A Between-Knee, Within-Person Comparison. Osteoarthritis And Cartilage, 22(10), 1634–1638. Https://Doi.Org/10.1016/J.Joca.2014.06.002

Setyaningrum, D. A. W. (2019). Cedera Olahraga Serta Penyakit Terkait Olahraga. Jurnal Biomedika Dan Kesehatan, 2(1), 39–44. Https://Doi.Org/10.18051/Jbiomedkes.2019.V2.39-44

Sonnery-Cottet, B., Hopper, G. P., Gousopoulos, L., Vieira, T. D., Thaunat, M., Fayard, J.-M., Freychet, B., Ouanezar, H., Cavaignac, E., & Saithna, A. (2022). Arthrogenic Muscle Inhibition Following Knee Injury Or Surgery: Pathophysiology, Classification, And Treatment. Video Journal Of Sports Medicine, 2(3). Https://Doi.Org/10.1177/26350254221086295

Tate, C. M., Williams, G. N., Barrance, P. J., & Buchanan, T. S. (2006). Lower Extremity Muscle Morphology In Young Athletes: An Mri-Based Analysis. Medicine And Science In Sports And Exercise, 38(1), 122–128. Https://Doi.Org/10.1249/01.Mss.0000179400.67734.01

Who. (2020). Who Guidelines On Physical Activity And Sedentary Behaviour.

Xie, P., István, B., & Liang, M. (2022). The Relationship Between Patellofemoral Pain Syndrome And Hip Biomechanics: A Systematic Review With Meta-Analysis. Healthcare, 11(1), 99. Https://Doi.Org/10.3390/Healthcare11010099