Markerless Pixel-Based Pipeline for Quantifying 2D Lower Limb Kinematics During Squatting: A Preliminary Validation Study

Background/Objectives: Marker-based motion capture remains widely used for lower limb kinematics due to its high precision, although its application is often constrained by elevated operational costs and the requirement for controlled laboratory environments. Markerless methods, such as MediaPipe offer a promising alternative for extending biomechanical analyses beyond traditional laboratory settings, but evidence supporting their validity in controlled tasks is still limited. This study aimed to validate a pixel-based markerless pipeline for two-dimensional kinematic analysis of hip and knee motion during squatting. Methods: Ten healthy volunteers performed three squats with a maximum depth of 90°. Kinematic data were collected simultaneously using marker-based and markerless systems. For the marker-based method, hip and knee joint angles were calculated from marker trajectories within a fixed coordinate system. For the markerless approach, a custom pixel-based pipeline was developed in MediaPipe 0.10.26 to compute bidimensional joint angles from screen coordinates. A paired t-test was conducted using Statistical Parametric Mapping, and maximum flexion values were compared between systems with Bland–Altman analysis. Total range of motion was also analyzed. Results: The markerless pipeline provided valid estimates of hip and knee motion, despite a systematic tendency to overestimate joint angles compared to the marker-based system, with a mean bias of −17.49° for the right hip (95% LoA: −51.89° to 16.91°). Conclusions: These findings support the use of markerless tools in clinical contexts where cost and accessibility are priorities, provided that systematic biases are taken into account during interpretation. Overall, despite the systematic differences, the 2D MediaPipe-based markerless system demonstrated sufficient consistency to assist clinical decision-making in settings where traditional motion capture is not available.