Anatomical Risk Factors for Lower Extremity Musculoskeletal Disorders and Proposed Prevention Strategies

Knee osteoarthritis (OA), patellofemoral pain, and anterior cruciate ligament (ACL) injuries are major musculoskeletal disorders often treated through conservative or postoperative physical therapy. Patellofemoral pain syndrome and patellar instability have been linked to femoral morphology specifically femoral anteversion (proximal) and trochlear groove (distal), as well as patellofemoral joint malalignment. Knee OA has been associated with an increased medial proximal tibial angle, indicating tibial varus alignment. ACL injuries are linked to abnormal bony morphology, including femoral intercondylar width, alpha angle, and posterior tibial slope angle. Preventing these abnormalities may reduce the risk of future diseases. Recent animal studies have shown that insufficient mechanical loading during growth alters bone geometry and joint alignment, which are risk factors for these musculoskeletal disorders. This review summarizes the bone morphological abnormalities and joint malalignments implicated in major lower limb musculoskeletal disorders, which have not been traditionally considered as therapeutic targets.