A reliable Q angle measurement using a standardized protocol

Merchant, Alan C.; Fraiser, Ryan; Dragoo, Jason L.; Fredericson, Michael

doi:10.1016/j.knee.2020.03.001

Cited by 22 publications

(12 citation statements)

References 19 publications

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“…For patients in the supine and extended knee position, the results of the Q angle measurements using an extendable fixed arm goniometer and ARNA (in relaxed quadriceps: 18.44° ± 2.80°; in MVC of quadriceps: 16.41° ± 2.83°) were found to be consistent with the literature. When compared to the literature, the Q angle measurements of women with relaxed quadriceps in the supine position were similar to the measurements of symptomatic female individuals in the same position (Almeida et al, 2016;Draper et al, 2011;Guerra et al, 1994;Merchant et al, 2020;Shiva Prakash et al, 2019;Woodland & Francis, 1992) but higher than the mean measurements of asymptomatic female individuals (Aglietti et al, 1983;Draper et al, 2011;Merchant et al, 2020;Raveendranath et al, 2020;Shiva Prakash et al, 2019;Woodland & Francis, 1992). In Almeida et al's evaluation of 22 individuals in the supine position with PFPS, they found a mean Q angle of 17.8° ± 2.7º (Almeida et al, 2016).…”

Section: Resultssupporting

confidence: 70%

“…In a study comparing symptomatic and asymptomatic individuals in a relaxed supine position, the means of Q angle were found to be 20° and 17°, respectively (Aglietti et al, 1983). Moreover, a study using an extendable fixed-arm goniometer to standardize the Q angle found a mean angle of 15.9° ± 4.8° in its measurements of asymptomatic female subjects (Merchant et al, 2020). In a study that measured participants in a relaxed supine position with computed tomography, the patella was more significantly situated in the lateral tilt position of the PFPS group than the healthy group.…”

Section: Resultsmentioning

confidence: 99%

“…For the first measurement, the MP was marked on adhesive tape while the quadriceps was relaxed. The measurement was made so that the goniometer's fixed arm showed the ASIS and the moving arm showed the TT (Biedert & Warnke, 2001;Brattström, 1964;Merchant et al, 2020;Messier et al, 1991). After the adhesive tape was removed, the patients were asked to perform a maximum isometric contraction of the quadriceps.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of patients with PFPS using a standardized Q angle measurement protocol

Songur

Demirdel

2020

Turkish Journal of Kinesiology

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An important concept in patellofemoral joint function is the quadriceps angle (Q angle), but there is a standardization problem with the measurement method. The aim of the study was to compare the change of the Q angle in relaxed or maximum voluntary contraction (MVC) of the quadriceps using a standardized measurement method in patients with patellofemoral pain syndrome (PFPS). This cross-sectional analytical study includes 34 sedentary female patients aged 18-50 years with a diagnosis of PFPS. Measurements were carried out with a manual extendable fixedarm goniometer. For the first measurement, the patient was placed in quadriceps relaxed in supine position. Lower extremity rotation was neutralized using the axial rotation neutralizing apparatus (ARNA). For the second measurement, while the quadriceps was maximally contracted in the same position the midpoint of the patella was re-marked and then the measurement was repeated. The Q angle measurements taken in quadriceps relaxed and MVC were 18.44° ± 2.80° and 16.41° ± 2.83°, respectively (p = .00). It was determined that there was no correlation between age, height, weight, body mass index (BMI), leg length and Q angle measurements of the participants (p > .05). In conclusion, this measurement method offered measurement estimations that verified the effect of the quadriceps on the Q angle in patients with PFPS. The prevention of axial rotation in the leg and the use of an extendable fixed-arm goniometer contribute to the standardization of Q angle measurement.

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Section: Resultssupporting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Evaluation of patients with PFPS using a standardized Q angle measurement protocol

Songur

Demirdel

2020

Turkish Journal of Kinesiology

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“…The values of quadriceps femoris angle documented by several researchers globally vary according to the population involved in the study, thus confirming racial variation [8,9]. However, the accepted normal quadriceps femoris angle ought to be between 12 to 20 degrees.…”

Section: Introductionsupporting

confidence: 60%

Analysis of Predictors Affecting Biomechanical Function of the Knee Joint and Its Relation to Anterior Knee Pain

Chaudhary¹,

Jain²,

Sharma³

et al. 2022

Cureus

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Background: Anterior knee pain is the most common problem in the young and sporting population. Quadriceps femoris angle and condylar distance are tools to assess the bio-mechanical function of the knee joint. The aim of this research was to give comparative data of quadriceps femoris angle and condylar distance in the Indian population (sedentary/sportsperson). The study also aims to know which parameter (condylar distance/quadriceps angle) is the better predictor for knee pain in the young Indian population.Materials and methods: This study was composed of a total of 130 individuals suffering from anterior knee pain which was divided into two categories; Sedentary and sportsperson. Each category consisted of 65 individuals. Q angle (goniometric method) and condylar distance (manual caliper) of each participant were calculated. A comparison of body parameters was done by independent t-test. Comparison between the two parameters (condylar distance and quadriceps angle) was done to know which is the better predictor of anterior knee pain.Results: Statistically significant sexual variation (p<0.05) was observed in both quadriceps angle and condylar distance in sedentary and sportsperson groups. Females had a higher value of Q angle than males (p<0.05). The difference in quadriceps angle was statistically significant (p<0.05) between sedentary and sportsperson groups. Cohen's kappa coefficient of Q angle was 0.72 while that of bi-condylar distance was 0.49. Conclusion: Q angle is a better indicator for anterior knee pain than condylar distance. Females in either category; sedentary and sportsperson, had higher Q angle in comparison to males making them more susceptible to disorders of the patellofemoral joint. Hence, encouragement and awareness are needed not only to carry out periodic screening of the susceptible population but also to emphasize its usage in clinical practice and the prognosis of the affected individual after treatment.

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“…There are serious problems in measuring both static and dynamic Q-angle [ 42 , 43 ]. Therefore, there is no agreement on the optimal way of measuring the angle, both static and dynamic.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of the Static and Dynamic Q-angle

Skouras¹,

Kanellopoulos²,

Stasi³

et al. 2022

Cureus

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Q-angle represents the resultant force vector of the quadriceps and patellar tendons acting on the patella. An increased Q-angle has been considered a risk factor for many disorders and injuries. This literature review challenges the clinical value of static Q-angle and recommends a more dynamic movement evaluation for making clinical decisions. Although there are many articles about static Q-angle, few have assessed the value of dynamic Q-angle. We searched Scopus and PubMed (until September 2021) to identify and summarize English-language articles evaluating static and dynamic Q-angle, including articles for dynamic knee valgus (DKV) and frontal plane projection angle. We also used textbooks and articles from references to related articles. Although static Q-angle measurement is used systematically in clinical practice for critical clinical decisions, its interpretation and clinical translation present fundamental and intractable limitations. To date, it is acceptable that mechanisms that cause patellofemoral pain and athletic injuries have a stronger correlation with dynamic loading conditions. Dynamic Q-angle has the following three dynamic elements: frontal plane (hip adduction, knee abduction), transverse plane (hip internal rotation and tibia external rotation), and patella behavior. Measuring one out of three elements (frontal plane) illustrates only one-third of this concept. Static Q-angle lacks biomechanical meaning and utility for dynamic activities. Although DKV is accompanied by hip and tibia rotation, it remains a frontal plane measurement, which provides no information about the transverse plane and patella movement. However, given the acceptable reliability and the better differentiation capability, DKV assessment is recommended in clinical practice.

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A reliable Q angle measurement using a standardized protocol

Cited by 22 publications

References 19 publications

Evaluation of patients with PFPS using a standardized Q angle measurement protocol

Evaluation of patients with PFPS using a standardized Q angle measurement protocol

Analysis of Predictors Affecting Biomechanical Function of the Knee Joint and Its Relation to Anterior Knee Pain

Clinical Significance of the Static and Dynamic Q-angle

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