n International SportMed Journal - Potential causes of chronic anterior knee pain in a former winner of the Tour de France : case report

Volume 9, Issue 4
  • ISSN : 1528-3356



Little focus has been placed on the effects of cadence on pedalling action and subsequent risk of knee related overuse injuries. Ergometers with the capacity to measure torque throughout the knee extension cycle of each leg's pedalling motion (i.e. Computrainer™ ergometer with Spinscan function) have the potential to provide the clinician with additional insight into the causes of anterior knee pain in selected patients. A 32-year-old male professional cyclist and former winner of the Tour de France with a 7-year history of recurrent anterior knee pain presented to the authors' Sports Medicine Clinic with an acute exacerbation of anterior right knee pain following early season volume-based training. MRI findings were of a low grade patellar tendinopathy. Isokinetic testing revealed increased eccentric knee flexion strength of the right (injured) vs. left leg (213.4Nm vs. 166.3Nm). The rate of fatigue for right knee concentric endurance extension was greater than the left leg (22.8% vs. 10.1%). A Computrainer Spinscan analysis was performed at cadences of 65-, 75-, 85-, 95- and 105rpm respectively. Mean power balance (51.0 ± 0.9%) was in favour of the right leg. This abnormality in power balance was most prevalent at cadences lower than 75rpm (51.9 ± 1.5%). Mechanical efficiency scores for cadences below 85rpm (57.8 ± 3.8%) were significantly lower than recorded for other elite male road cyclists in these authors' laboratory (70-85%). Right leg mean torque angles were lower for all cadences (84.3 ± 3.0) in comparison to the left leg. This was accentuated for cadences of 85rpm or lower (82.3 ± 2.4). These findings were consistent with a low grade infra-patellar tendinosis attributable to force overload induced by high volume, low cadence activity.

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