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Contact between the knees and knee bolster commonly occurs in frontal collisions. The contact region on the bolster and the knee anatomy involved are related to the pre-crash positioning of the knees. The location of the distal (or infra-) patella was recorded on volunteers of widely varying stature after they had selected a comfortable driving position in mockups of three vehicles representing a large variation in size and shape: sedan, crossover SUV, and full-size pickup. On average, the right knees were grouped more tightly and were located more forward and lower than the left knees. On average, the knees were positioned 200 mm from the knee bolster for all subjects. The range of distance separating the distal patellae (within subject knee-to-knee distance) varied from 184–559 mm for all subjects for the three vehicles.

Based on an analysis of the National Automotive Sampling System (NASS) database from calendar years 1995-2000, over 30,000 fractures and dislocations of the knee-thigh-hip (KTH) complex occur in frontal motor-vehicle crashes each year in the United States. This analysis also shows that the risk of hip injury is generally higher than the risks of knee and thigh injuries in frontal crashes, that hip injuries are occurring to adult occupants of all ages, and that most hip injuries occur at crash severities that are equal to, or less than, those used in FMVSS 208 and NCAP testing. Because previous biomechanical research produced mostly knee or distal femur injuries, and because knee and femur injuries were frequently documented in early crash investigation data, the femur has traditionally been viewed as the weakest part of the KTH complex.