Bilateral Variability of the Quadriceps Angle (Q angle) in an Adult Indian Population

Document Type : Original Article

Authors

1 Department of Anatomy, Sri Manakula Vinayakar Medical College, Pondicherry, India

2 Department of Anatomy, St. John’s Medical College, Sarjapur Road, Bangalore- 560034, Karnataka, India

Abstract

Objective(s)
The objective of this study was to document and explain bilateral differences in the Q angle.
Materials and Methods
Two hundred limbs of healthy adult Indian volunteers were studied. The Q angle was measured using a goniometric method with the subjects supine, quadriceps relaxed and lower limbs in neutral rotation. The relative lateral placement of the tibial tuberosity with respect to the centre of the patella was measured. Appropriate statistical tests were used to determine the bilateral variability in the Q angle and the lateral placement of the tibial tuberosity. Inter-observer variation of the above mentioned parameters were studied
in twenty limbs.
Results
The average Q angle value of all the 200 limbs was 12.73 °C; the mean value on the right was 12.86 °C and 12.60 °C on the left. When the Q angle and the lateral placement of the tibial tuberosity were considered in pairs a significant difference was noted in males. The Q angle value on the right side was more often greater than the left. The relative lateral placement of the tibial tuberosity showed a significant positive correlation with the Q angle. The intra-class correlation coefficient was 0.66 for the Q angle and 0.8 for the lateral placement of the tibial tuberosity.
Conclusion
The present study shows that bilateral variability in the Q angle could be attributed to an alteration of the relative placement of the tibial tuberosity with respect to the centre of the patella.

Keywords

References

1. Brattstrom H. Shape of the intercondylar groove normally and in recurrent dislocation of patella. Acta Orthop Scand Suppl 1964; 68:1-40.
2. Insall J, Falvo DA, Wise DW. Chondromalacia patellae: A prospective study. J Bone Joint Surg[Am] 1976; 58:1-8.
3. Livingston LA. The quadriceps angle: A review of the literature. J Orthop Sports Phys Ther 1998; 28:105–109.
4. Emami MJ, Ghahramani MH, Abdinejad F, Namazi H. Q-angle: An invaluable parameter for evaluation of anterior knee pain. Arch Iran Med 2007; 10:24-26.
5. Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dyn Med 2008; 26:7-9.
6. Sendur OF, Gurer G, Yildirim T, Ozturk E, Aydeniz A. Relationship of Q angle and joint hypermobility and Q angles in different positions. Clin Rheumatol 2006; 25:304-308.
7. Smith TO, Davies L, O’Driscoll ML, Donell ST. An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee 2008; 15:255-262.
8. Rauh MJ, Koespsell TD, Rivara FP, Rice SG, Margherita AJ. Quadriceps angle and risk of injury among high school cross country runners. J Orthop Sports Phys Ther 2007; 37:725-733.
9. Livingston LA, Mandigo JL. Bilateral within-subject Q angle asymmetry in young adult females and males. Biomed Sci Instrum 1997; 33:112-117.
10. Hahn T, Foldspang A. The Q-angle and sport. Scand J Med Sci Sports 1997; 7:43-48.
11. Livingston LA, Spaulding SJ. OPTOTRAK Measurement of the Quadriceps angle using standardized foot positions. J Athl Train 2002; 37:252-255.
12. Sra A, Ba T, Oo J. Comparison of bilateral Quadriceps angle in asymptomatic and symptomatic males with anterior knee pain. Internet J Pain Symptom Contr Palliative Care 2008; 6:1.
13. Byl T, Cole JA, Livingston LA. What determines the magnitude of the Q angle? A preliminary study of selected skeletal and muscular measures. J Sport Rehabil 2000; 9:26-34.
14. Belchior ACG, Arakaki JC, Bevilaqua-grossi D, Reis FA, Carvalho PTC. Effects on the Q angle measurement with maximal isometric contraction of the quadriceps muscle. Rev Bras Med Esporte 2006; 12:6-10.
15. Jha A, Raza HKT. Variation in Q-angle according to sex, height, weight and interspinous distance - A Survey. Int J Orthod 2000; 34:99-101.
16. France L, Nester C. Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech 2001; 16:710–713.
17. Roush JR, Bustillo K, Low E. Measurement error between a goniometer and the NIH image J program for measuring quadriceps angle. Internet J of Allied Health Sci Pract 2008; 6:2.
18. Greene CC, Edwards TB, Wade MR, Carson EW. Reliability of the Quadriceps angle measurement. Am J Knee Surg 2001; 14:97-103.
19. Sanfridsson J.Orthopaedic measurements with computed radiography: methodological development, accuracy, and radiation dose with special reference to the weight-bearing lower extremity and the dislocating patella. Acta Radiol 2001; 42:1-40.
20. Smith TO, Davies L, O’Driscoll ML, Donell ST. An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee 2008; 15:255-262.
21. Smith TO, Hunt NJ, Donell ST. The reliability and the validity of the Q angle: a systematic review. Knee Surg Sports Traumatol Arthrosc 2008; 16:1068-1079.
22. Shultz SJ, Ngyyen AD, Windley TC, Kulas AS, Botic TL, Beynnon BD. Intratester and intertester reliability of clinical measures of lower extremity anatomic characteristics: implications for multicenter studies. Clin J Sport Med 2006; 16:155-161.
Iranian Journal of Basic Medical Sciences
Volume 14, Issue 5 - Serial Number 5
September 2011
Pages 465-471

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