Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Proportion of Genu Valgum and Genu Varum in Students Aged 19-25 Years

Background:Knee joint mal alignments are divided into genu valgum and genu varum. The presence of these mal-alignments leads to complications like tibio-femoral osteoarthritis, compensatory changes in ankle/foot, etc.Taking a community of physiotherapy students, the proportion ofgenu varum, genu valgumand its association with body mass index (BMI) and foot posture index (FPI) was investigated. The aim of the study was to evaluate the proportion of genu valgum and genu varum in subjects aged 19 -25 years.Materials and Methods: The data was collected from D.Y. Patil University, Navi Mumbai. A consent form and a validated proforma was used. Age, BMI, FPI, IKD (Inter-knee distance), IMD (Inter-malleolar distance) and Q-angle was recorded, and the data was statistically analysed.Results: 45 out of 100 females had genu valgum which was found to be associated with higher BMI and pronated feet. 9 out of 100 females had genu varum which was found to be associated with lower BMI. Chi-square test was done to find out these associations.Conclusion: Awareness of the proportion of angular mal-alignment in knee would increase the recognition of this problem among the individuals and doctors for better execution of strategies that can help avoid these mal-alignments.

A Study on the Effect of Isometric Quadriceps Activation and Vastus Medialis Obliquus Strengthening in Decreasing Q-Angle among Young Females

Females are more prone for lateral displacement of patella than males due to increased Q-angle (15–18°) in them compared to males (12–15°). In a normal state, lateral displacement is prevented by geometry of the joint and by the passive stabilizers. Even though contraction of the quadriceps tends to displace the patella laterally, vastus medialis oblique (VMO) acts medially and posteriorly as much as it acts proximally, and so its tension helps in resisting the Q angle effect. There are two procedures in common practice to reduce Q-angle and thereby to prevent lateral displacement of patella– either through vastus medialis oblique (VMO) strengthening or by isometric quadriceps activation (quadriceps muscle strengthening). We wanted to compare the effects of isometric quadriceps activation and VMO strengthening in reducing Q angle in a group of young females.METHODSA non-randomized, two group, pre-test, post-test assessment of Q-angle was done. Twenty healthy females of 18-20 age group were selected and randomly divided into two groups. Isometric quadriceps activation and VMO strengthening was done for 4 weeks. Q-angles were measured before and after the strengthening exercise using a long arm goniometer.RESULTSThe mean q angle before treatment was 21. (minimum 20 and maximum 23). While after the treatment, q angles were significantly reduced in both the groups and mean q angle was 16.3.CONCLUSIONSBoth the isometric quadriceps activation and VMO strengthening reduced Q-angle significantly and there was no significant difference between the two procedures. Results of this study help the physiotherapist in choosing the exercise for the management of patellofemoral pain and lateral displacement of patella.

Changes In Quadriceps Angle (q-angle) With Regard To Gender And Different Anthropometric Parameters

Introduction: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadricepsfemoris muscle and the patellar tendon. It has a great clinical and biomechanics significance. The present studywas planned so as to study Q-angle in healthy young adult individuals and establish its relationship withdifferent anthropometric parameters.Material and methods: The subjects for the study were normal healthy young adult medical students from A.C.S.medical college, Chennai, India.148 subjects (80 girls and 68 boys)were studied. Males and females between theage of 18-20 years were included in the study. Q-angle was measured using standard goniometer. The Q-angle indegree was measured on both sides.These Q-angles were correlated with various anthropometric parameters (height, weight, BMI, WHR, pelvicwidth, femur length).Results: The mean Q-angle in males on left side was 8.1+1.83and that on right side was 8.6 +2.20The mean Q-angle in females on left side was 8.8+ 2.33 and that on right side was 8.9 + 2.52. There were nosignificant bilateral differences The Q-angle (Left) and Q-angle (Right) are significantly correlated with Weight(Kg), Waist (cm) and Hip (cm). However, these angles are not correlated with Weight for height or Waist for Hipratio, pelvic width and femur length in females.In case of males, height, BMI, Pelvic width measurements werefound to be correlated with Q-Left and Q-Right angle. Femur length was correlated only with Q-Left angle whilethere was no correlation with Q-Right angle.Conclusion: No significant differences in both gender was also noted, No significant bilateral differences wereseen. According to our study Q-angle does not vary with the age. Several anthropometric measures on correlatingwith Q-angle signify that irrespective of gender higher Q-angles are seen with those having high BMI, increasedwaist and hip-circumference.

Test de Zohlen y su relación con el ángulo Q en población sin dolor patelofemoral / Zohlen's test and its relation to the Q angle in a population without patellofemoral pain

Determinar qué porcentaje de una población sin dolor anterior de rodilla tiene un test de Zohlen positivo, además determinar el ángulo Q de esta población y buscar si existe alguna relación entre la positividad del test de Zohlen y alteraciones en el ángulo Q. Material y método: Estudio descriptivo-prospectivo observacional. Aplicación del test de Zohlen y medición del ángulo Q. La población se dividió en 2 grupos: test de Zohlen positivo y test de Zohlen negativo. Cuantificación y comparación de medias del ángulo Q en los dos grupos. Resultados: 90 sujetos evaluados, promedio de edad 20,18 años (18-40). Veinte sujetos (22,2 por ciento) con test de Zohlen positivo. Ángulo Q promedio en los sujetos con test de Zohlen negativo: 14,95°; ángulo Q promedio en los sujetos con test de Zohlen positivo: 16,9° (p < 0,05). Ángulo Q promedio en hombres con test de Zohlen negativo 13,4°; ángulo Q promedio en hombres con test de Zohlen positivo: 16° (p < 0,05). Ángulo Q promedio en mujeres con test de Zohlen negativo: 16,5°; ángulo Q promedio en mujeres con test de Zohlen positivo: 18°, sin diferencias estadísticamente significativas entre ambos grupos. Conclusiones: El test de Zohlen tiene una correlación positiva con el ángulo Q en sujetos de sexo masculino. Dada la correlación entre un ángulo Q alterado y la presencia de dolor anterior de rodilla, en los pacientes que presentan un test de Zohlen positivo sin haber consultado por dolor anterior de rodilla, la prevención primaria de dolor anterior de rodilla puede ser de utilidad...

To determine the percentage of a population without anterior knee pain with a positive Zohlen test, and also to determine the Q angle of this population and to determine if there is any relationship between the Zohlen test and Q angle anomalies. Methods:A prospective observational study was conducted in which Zohlen¿s test was applied and the Q angle was measured. The population was divided into 2 groups: Zohlen¿s positive and Zohlen¿s negative. Q angle was compared in the 2 groups. Results: The study included 90 subjects, with a mean age 20.18 years (18-40), of whom 20 subjects (22.2 percent) had positive Zohlen¿s test. The mean Q angle in subjects with negative Zohlen¿s test was 14.95°, and the mean Q angle in subjects with positive Zohlen¿s test was 16,9° (p<.05). The mean Q angle in men with negative Zohlen¿s test was 13.4°, and the mean Q angle in men with positive Zohlen¿s test was 16° (p < .05). The mean Q angle in women with negative Zohlen¿s test was 16.5°, with a mean Q angle of 18° in women with positive Zohlen¿s test, with no statistically significant differences found between groups. Conclusions: Zohlen¿s test has a positive correlation with the Q angle in male subjects. Given the correlation between the Q angle and the presence of anterior knee pain in patients who have a positive test without symptoms, primary prevention of anterior knee pain can be achieved...

Evaluation of clinical and radiographic measures and reliability of the quadriceps angle measurement in elderly women with knee osteoarthritis / Avaliação das medidas radiográficas e clínicas e confiabilidade do ângulo do quadríceps em idosas com osteoartrite de joelhos

Introduction Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population.

Introdução A osteoartrite (OA) de joelhos é uma doença degenerativa complexa com alterações intra-articulares que comprometem a amplitude do ângulo do quadríceps (Q). Para mensuração dessa variável, é necessária a utilização de protocolos que apresentem confiabilidade, visando reprodutibilidade metodológica. Objetivo Avaliar a confiabilidade intra e interexaminadores das medidas clínicas e radiográficas do ângulo Q e verificar se existe relação entre o grau de OA e a magnitude deste ângulo em idosas. Materiais e métodos 23 voluntárias, tiveram o ângulo Q mensurado por 2 avaliadores, com intervalo de 48 horas. As medidas clínicas foram coletadas por meio do goniômetro universal na mesma posição adotada no exame radiográfico. Resultados A confiabilidade intraexaminador foi boa (0,722–0,763) nas medidas radiográficas e baixa (0,518–0,574) nas medidas clínicas, enquanto a confiabilidade interexaminadores foi moderada (0,634) nas medidas radiográficas e baixa (0,499) nas clínicas. A análise da correlação entre os valores radiográficos com a classificação da OA não demonstrou correlação entre os mesmos (p = 0,824 e r = -0,024). Conclusão Clinicamente, sugere-se que o exame radiográfico seja preferível para avaliação do ângulo Q de idosas com OA de joelhos. Além disto, a magnitude deste ângulo não se relacionou com o grau de acometimento da OA nesta população.

The Q angle analysis, during resistance training, on open kinematics chain and intermidiate closed kinematics chain, through photogrametry / Análise do ângulo Q, durante o treinamento resistido, em cadeia cinemática aberta e cadeia cinemática fechada intermediária através de fotomiografia / Análisis del ángulo Q, durante el entrenamiento de resistencia en cadena cinética abierta y cadena cinemática cerrada intermedia mediante Microfotografía

To examine the Q angle, during the resistance training by "Leg Press 45" and the "extensor chair". 14 female subjects practitioners gym carried out exercises at OKC and ICKC, ranging from 0° to 90° of flexion, where images were recorded each 10°. Through SAPO v.068, the Q angles were measured; and conducted a T-test for independent samples with p<0.05. The resistance training should include muscle exercises in OKC and ICKC, with special attention to the last one, contradicting the view of some authors. The Q angle, when compared to OKC and ICKC, changed with the increase of bending the knee for both knees to normal as the valgus, validating the combination of exercises in OKC and ICKC in muscle strengthening, for possible trend to the pathologic valgus.

Analisar o ângulo Q, durante o treinamento resistido no "Leg Press 45º" e na "Cadeira Extensora". 14 indivíduos do gênero feminino praticantes de treinamento resistido executaram um exercício em CCA e um em CCFI, variando de 0 a 90º de flexão onde eram registradas imagens frontais a cada 10º de amplitude. Através do SAPo v.068, foram medidos os Ângulos Q e com as médias por grupos, realizado um Teste t para amostras independentes com p<0,05. O ângulo Q, quando comparado em CCA e CCFI, alterou-se com o aumento da flexão do joelho, tanto para os joelhos normais quanto para os valgos, então é válida a combinação de exercícios em CCA e CCFI no fortalecimento muscular, tendo o devido cuidado com a tendência ao valgismo patológico determinada pelo ângulo Q.

Analizar el ángulo Q, durante el entrenamiento de resistencia en el "Leg Press 45°" y la "máquina de extensión de la pierna". 14 sujetos de sexo femenino realizó un ejercicio de entrenamiento de resistencia en CCA y una en CCCI, que van desde 0 a 90º frente a donde las imágenes se registraron cada 10 grados de amplitud. A través de SAPO v.068, ángulos Q fueron medidos y las medias por grupos, llevó a cabo un test t para muestras independientes con p <0,05. El ángulo Q, cuando comparado en CCA y CCCI, cambiado con el aumento de la flexión de rodilla de ambas rodillas en valgo y para las normales. Es válida una combinación de ejercicios en CCA y CCCI el fortalecimiento del músculo, teniendo el debido cuidado con la tendencia a valgus patológico determinada por el ángulo Q.

Angulo Q extendido: un nuevo signo clínico para decidir técnica de realineación distal de aparato extensor / Extended Q angle: a new sign for the physical exam for deciding distal realignement

Los trastornos patelofemorales son una de las causas más frecuentes de consulta en ortopedia, y múltiples son los factores etiológicos descriptos en la fisiopatogenia. Un examen físico completo es imprescindible para detectar él o los factores influyentes en cada paciente para realizar un tratamiento “a la carta”. En la bibliografía se suele considerar a la realineación distal del aparato extensor como sinónimo de transposición de la TAT, sin embargo este concepto no contempla el factor rotacional generador de grandes fuerzas desestabilizantes en esta articulación. En este trabajo se describe un signo semiológico muy útil para decidir la realineación distal del aparato extensor, donde se agrega un vector más al ángulo Q clásico, desde el polo inferior de la rótula y paralelo a la diáfisis tibial y su relación con la posición del pie. Este signo se mide con rodilla en 30° de flexión, rótulas al cenit. Se describen 2 tipos de ángulo Q aumentado, contemplando la posición del pie que es fundamental para detectar trastorno rotacional con intrarotación de rodilla durante la marcha. También se describe y fundamenta la necesidad de diferenciar los 2 tipos de ángulo Q extendido para un tratamiento de realineación distal que respeta la biomecánica patelofemoral.

Patellofemoral problems are one of the most common cause of consult in orthopaedic practice. Multiple etiologic factors have been described in the genesis of the pathology. A complete physical exam is very important for the detection of factors that affect each patient, so that we can make a “a la carte” treatment. In the literature the distal realignement is consider as sinonym of transfer of the tibial tuberosity, but this concept not consider the rotational influence that generate grate forces at the articulation. Here we describe a new sign for the physical exam, useful for deciding distal realignement, where we add and other vector from the distal pole of the patella and paralel to the tibial diafisis and the relantionship with the foot. The sign must be taken in 30° of knee flexion, patellas facing straight to the cenit . We find that there is two types of extended Q angles considering the position of the foot and the presence of a rotational problem wich produce an inward knee. We describe the importance of different type of treatment for each extended Q angles in distal realignement procedures considering more physiological and anatomic treatment for patellofemoral problems.

Relação entre o ângulo quadriciptal (ÂQ) e a distribuição da pressão plantar em jogadores de futebol / Relationship between quadriceps angle (Q) and plantar pressure distribution in football players

OBJETIVOS: Verificar possível associação entre ângulo quadriciptal (ÂQ) e distribuição de pressão plantar em jogadores de futebol, comparando-os com indivíduos não praticantes da modalidade. MÉTODOS: Cento e vinte e um participantes do sexo masculino foram selecionados: 50 jogadores de futebol (JF) e 71 sujeitos para o grupo controle (GC). Avaliaram-se concomitantemente o ÂQ, por meio do Software para Avaliação Postural (SAPO), e a pressão plantar, pela plataforma F-Scan/F-Mat System. Para verificar correlação entre o ÂQ e os valores de picos de pressão em quatro segmentos do pé (antepé medial e lateral, médio-pé e retropé), utilizou-se o Coeficiente de Pearson (r) para análises paramétricas. O teste t independente foi empregado para comparar isoladamente essas mesmas variáveis entre os grupos. A normalidade dos dados foi verificada pelos valores de skewness, adotando nível de significância de 5 por cento. RESULTADOS: Encontrou-se correlação negativa e fraca (r=-0,32) somente entre ÂQ e médio-pé direito. Os grupos diferiram quanto ao ÂQ bilateralmente, sendo que o grupo JF teve média de 11,36º, e GC, de 13,80º à direita e de 11,03º contra 13,96º à esquerda, respectivamente. Em relação à pressão plantar, o JF teve maior média de força nas faces laterais do antepé direito (0,77 contra 0,63 kg/cm²) e esquerdo (0,65 e 0,54 kg/cm²), enquanto o GC apresentou maior pico de pressão no médio-pé esquerdo (JF: 0,37 e GC: 0,46 kg/cm²). CONCLUSÕES: Não houve relação entre os valores de ÂQ na distribuição da pressão plantar nos jogadores de futebol. Os atletas apresentaram, porém, ÂQ diminuído e maiores picos de pressão nas faces laterais de ambos os pés, o que sugere alinhamento em varo dos joelhos e distribuição supinada das bases plantares.

OBJECTIVES: To determine whether there is an association between the Q-angle (Q) and the distribution of plantar pressure in football players, and to compare the characteristics of these athletes with non-practitioners of this sport. METHODS: 121 male participants were selected: 50 football practitioners (FP) and 71 non-practitioners (NP). We concurrently evaluated the Q-angle and the plantar pressure through the software of postural assessment (SPA) and the F-Mat System, respectively. To verify the correlation between the Q-angle and peak pressure values in four segments of the foot (medial and lateral forefoot, medium-foot and hind-foot), the Pearson coefficient (r) for parametric analysis was used. The independent t-test was used to compare these variables between the groups. Data normality was verified by the skewness values, adopting a significance level of 5 percent. RESULTS: A negative and weak correlation was found (r=-0.32) between the Q-angle and the plantar pressure in the right medium-foot. The groups differed with regards to the right Q-angle (11.36º in FP versus 13.80º in NP) and the left Q-angle (11.03º in FP versus 13.96º in NP). Plantar pressure was also different between the groups, with FP showing higher mean values for the right side and for the left side of the forefoot (0.77 kg/cm² in FP versus 0.63 kg/cm² in NP, and 0.65 kg/cm² in FP versus 0.54 kg/cm² in NP, respectively). However, mean peak pressure values for the left medium-foot were higher among NP (0.37 kg/cm² in FP versus 0.46 kg/cm² in NP). CONCLUSIONS: There was no evidence of an association between the Q-angle and the distribution of plantar pressure in FP. The athletes showed reduced Q-angle values and higher mean peak pressure values for the right and left aspects of the forefoot, suggesting a varus malalignment and a supine distribution of plantar bases.

Effect of isometric quadricep activation on “Q” angle in young females.

The Q angle represents an estimate of the resultant force of the quadriceps on the patella and is a predictor of the lateral movement of the patella under dynamic conditions. The aim of the present study was to observe whether Isometric Quadriceps Activation (IQA) can decrease the Q angle and to identify people at high risk of patellar subluxation. Q angles were measured in 23 non impaired young women (22.9±2.3 years) in relaxed standing and during IQA. There was a significant decrease (4.65±2.74°) in the Q angle values for subjects with IQA as compared to subjects with measurements in relaxed standing Significance levels were set at P<0.05. The Q angle decreases with IQA which was highly significant (t=8.01, P<0.001). The result supports the view that an excessive Q angle may predispose women to greater lateral displacement of the patella during vigorous activities and sports in which the quadriceps muscle is stressed.

A study of lower limb injuries in aerobic dance instructors / 体力科学

The purpose of this study was to investigate the injurious influence of aerobic dancing on the lower limbs injuries. Subjects were personally interviewed about exercise hours and the intensity of their classes, together with experience of injury, and their body configurations, alignments, ranges of motion, and muscular strengths were measured. EMG during aerobic dance exercise was measured in subjects with knee Q angles over and under 20 degrees.<BR>The incidence of lower limb injury was 64.3%, and the most frequent injury was shin splint. The injured individuals had significantly more high-intensity classes than normal. As to body configuration, the width in patella per femur was significantly lower and the value of patellar ligament per height was significantly higher in the injured than in the normal subjects. The range of motion of hip external rotation in the injured was significantly smaller than that in the normal subjects. EMG discharge of the vastus medialis in the injured with a knee Q angle of over 20 degrees was markedly greater than that in normal subjects with an angle of less than 20 degrees.