Internal Hip Rotation and Swing Phase Knee Flexion in Adolescent Gait Case Study
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Keywords
gait analysis, stiff knee gait, anteversion
Abstract
Introduction: Stiff knee gait (SKG) is a common gait deviation in patients with cerebral palsy that can significantly impact walking function. SKG is often treated surgically with a distal rectus femoris transfer, however some researchers have documented mixed outcomes using existing patient selection criteria. It may be that other factors, such as hip internal rotation due to increased femoral anteversion, are playing a role in SKG, though this has not been explicitly studied.
Methods: This descriptive case study involved a convenience sample of two 14-year-old adolescent girls, one with idiopathic increased internal hip rotation and one without. Lower body joint angles were calculated from motion capture data collected during normal overground walking. Two variables were extracted from each of 60 gait cycles (30 per side): peak knee flexion in swing, and average hip rotation in early swing. Two-way ANOVAS with participant and leg as factors, followed by Welch t-tests for significant interactions, were used to compare participants statistically. Given the non-independence of gait cycles within participants, a conservative threshold of p<0.001 was applied.
Results: The participant who presented with idiopathic increased femoral anteversion walked with atypically high internal hip rotation in early swing compared to the participant without clinically increased femoral anteversion. In addition, the participant with higher internal hip rotation exhibited decreased peak knee flexion during swing. Statistical comparisons confirmed significant between-participants differences in both variables for each leg (p<0.001).
Conclusions: Increased internal hip rotation in the early swing phase of gait may be a factor in the decreased swing phase peak knee flexion characteristic of SKG. Given the importance of patient selection for the treatment of SKG, further study in a larger sample with a wide range of severity of femoral anteversion may be warranted.
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Copyright, 2026 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.
Krisanne Chapin, Grand Valley State University
Department of Movement Science
Assistant Professor