Quadriceps Angle Research Articles

Immediate Effect of Hamstring Stretching on Q Angle, Flexibility, and Balance in Individuals with Hamstring Tightness

Objective: Hamstring tightness is a common problem that can affect the quadriceps angle, flexibility of knee extension, and balance. The purpose of this study was to investigate the immediate effects of passive static hamstring stretching on the quadriceps angle, knee joint range of motion (ROM), and static and dynamic balance in people with hamstring tightness.Material and Methods: A total of 52 male participants were randomly divided into two groups: a stretching group and a control group. All participants underwent a physical therapy examination before the experiment (Pre-test), including an Active Knee Extension Test, quadriceps angle (Q angle) measurement, and static balance and dynamic balance assessments. After that, the stretching group received passive static hamstring muscle stretching, while the control group received knowledge about the tightness of the hamstring muscle. After the experiment, all participants underwent a physical therapy examination using the same testing method.Results: The study found that passive static hamstring muscle stretching increased the knee extension ROM by 5.54±3.78 degrees (p-value<0.01) and decreased the Q angle by -1.85±1.46 degrees (p-value<0.01) compared to the control group. However, there were no significant differences between the groups for the balance outcomes.Conclusion: This study found that passive static hamstring muscle stretching improved knee extension and decreased the Q angle. These findings can confirm the positive effects of exercise for increasing flexibility among individuals with tight hamstrings and abnormal Q angle.

Effect of body mass index on quadriceps angle and tibial torsion in school-aged children

BackgroundThe prevalence of excessive body mass (BMI) is increasing in pediatric population. Accordingly, the number of musculoskeletal problems in this population is also likely to increase. The quadriceps angle (Q-angle) is a clinical measure used to measure knee alignment in relation to the hip, femur, and tibia, as well as evaluating alignment of the patella. Tibial torsion (T.T) is an important morphological feature of human tibia. The aim of that study was to study the relationship between the Q-angle and TT in children 8 to 12 years old, the effect of BMI on Q-angle and T.T, and the difference in Q-angle and TT between dominant and non-dominant side.Results“Seventy-five children from primary schools” were enrolled in the study and allocated into 3 groups (25 subjects in each group), according to BMI: group I (normal weight = 25), group II (overweight = 25), and group III (obese = 25). The mean value of age of groups I, II, and III was 10.35 ± 1, 10.74 ± 1.2, and 10.17 ± 1.18 years respectively; the mean value of weight was 29.88 ± 3.94, 43.68 ± 6.55, and 50.06 ± 10.44 kg respectively; the mean value of height was 135.28 ± 7.63, 143.2 ± 8.85, and 140.72 ± 9.3 cm respectively; and the mean value of BMI was 16.22 ± 1, 21.18 ± 1.4, and 25.17 ± 2.67 kg/m2. The number (%) of boys in groups I, II, and III was 15 (60%), 18 (72%), and 17 (68%) respectively and of girls was 10 (40%), 7 (28%), and 8 (32%) respectively.The significant values were Q-angle and TT. Data were expressed as mean ± SD. ANOVA was used to compare between subjects’ characteristics of the groups. Kolmogorov-Smirnov test was used for testing normality of data distribution. One-way MANOVA was used to compare parametric variables (Q-angle and TT) between the two groups. Compared with normal weight children, there was statistically significant increase in Q-angle and TT angle in overweight and obese children.ConclusionAny change in BMI would eventually lead to change in both Q-angle and TT angle. The greater the BMI values, the greater the values of Q-angle and TT angle.

Investigation of the relationship between hallux valgus, quadriceps angle, and body image perception in young adults

Purpose: Our study aimed to identify the presence and severity of hallux valgus deformity in young adults, using both by the Manchester classification and goniometry, to evaluate the Quadriceps angle (Q angle), and to examine the relationship between some anatomical parameters and body image perception. Materials and Methods: A total of 158 individuals aged 18-30 (111 females, 47 males) who voluntarily agreed to participate in the study were included. Demographic characteristics, Quadriceps angle, and hallux valgus angle were measured. Hallux valgus and Quadriceps angles were determined using a goniometer, while the Manchester scale was employed to evaluate the level of Hallux valgus deformity. The Golden Ratio for the lower extremity was calculated by taking the ratio of lower extremity length to leg length, and the body image perception score was determined. Results: Body weight, height and body mass index showed statistically significant differences in terms of gender, while age parameter did not show statistically significant difference between genders. Also, no significant difference in Quadriceps angle was observed between genders for both right and left sides, while a significant difference in Hallux valgus angle was noted. A high, positive, and significant relationship was found between Manchester classification and hallux valgus, while Golden ratio values did not significantly differ by gender. Additionally, body image perception scores were higher in males (162.60±25.45 points) than in females (153.51±25.89 points). Conclusion: Deviations from their normal values of the hallux valgus and quadriceps angle which affect the musculoskeletal system, may lead to some health problems, as well as difficulties in performing daily life activities, and concerns about aesthetics. Failure to fulfil one’s normal functions or not to find oneself aesthetically insufficient will also make it likely that the body image perception will deteriorate.

Quadriceps angle as an outcome measure for structural integrity following total knee arthroplasty in individuals with severe knee osteoarthritis

PurposeTotal knee arthroplasty (TKA) is routinely performed for pain relief and to improve performance of the knee in individuals with severe knee osteoarthritis (OA). The quadriceps angle (Q-angle) is a key component of knee joint stability. However, there is a dearth of literature evaluating Q-angle as an outcome measure after TKA in individuals with severe knee OA. ObjectivesThe objective of the study was to assess the Q-angle as an outcome measure before and after TKA and to find the correlation of Q-angle with pain, quadriceps strength, and knee flexion range of motion (ROM) after TKA in individuals with severe knee OA. MethodsThe Q-angles of 34 individuals (male: female = 17:17) were measured using standardized procedures. Pain, quadriceps strength, and knee flexion ROM were measured. The measurements were taken preoperatively (one day before surgery), and postoperatively at the sixth week and third month after TKA. ResultsThe mean Q-angle was 19.17° (SD = 1.92°) before TKA, 16.06° (SD = 1.87°) at the sixth week and 13.43° (SD = 1.77°) at the third month after TKA. Significant linear correlations were noted between the Q-angle and pain, quadriceps strength, and knee flexion ROM following TKA. ConclusionThe Q-angle was measured before and after TKA using a standardized clinical goniometric method. Understanding the Q-angle before and after TKA and its relationship with various clinical and functional variables is imperative in clinical practice for orthopedic surgeons and rehabilitation professionals.

Estimation of Patellofemoral Joint Dysfunction in Obese Post menopausal Women

Purpose: The purpose of this research was to estimate Patellofemoral Joint Dysfunction in obese postmenopausal women. Methods: Depending on selection criteria, 100 obese postmenopausal women were selected by simple random sampling method. Written consent was taken and a detailed outcome assessment was done by using a Numerical Pain Rating Scale for pain assessment, Range of motion of hip, knee, ankle joint, Waldron Test, Eccentric Step-down Test, and Quadriceps angle. Statistical analysis was done and results were obtained. Findings: Among the 100 participants, 63% of women experienced pain during their daily activities. The mean pain intensity at rest was 2.25 ± 1.91, and during activity, it increased to 3.28 ± 6.60 (p value < 0.0001). The range of motion in the hip, knee, and ankle joints was reduced compared to that of individuals in the same age group without pain. Specifically, Hip extension-adduction, knee extension, and ankle plantarflexion-inversion-eversion had a p value of <0.0001. For hip flexion-abduction-medial and lateral rotation, knee flexion, and ankle dorsiflexion, the p values were 0.0003, 0.1952, 0.0001, 0.003, 0.0392, and 0.0333. Additionally, 35% of women had quadriceps angles greater than 180 degrees, while the remaining 65% had angles less than 180 degrees. 63% of women exhibited crepitus during activities like stair climbing and walking. 52% of women tested positive on the Waldron Test. 60% of women showed positive findings on the Eccentric Step-down Test. Conclusion: It concluded that there is significant Patellofemoral Joint Dysfunction in obese postmenopausal women.

The Influence of Social Media on Millennial Generation Community Participation in Sports Activities

Purpose: The purpose of this research was to estimate Patellofemoral Joint Dysfunction in obese postmenopausal women. Methods: Depending on selection criteria, 100 obese postmenopausal women were selected by simple random sampling method. Written consent was taken and a detailed outcome assessment was done by using a Numerical Pain Rating Scale for pain assessment, Range of motion of hip, knee, ankle joint, Waldron Test, Eccentric Step-down Test, and Quadriceps angle. Statistical analysis was done and results were obtained. Findings: Among the 100 participants, 63% of women experienced pain during their daily activities. The mean pain intensity at rest was 2.25 ± 1.91, and during activity, it increased to 3.28 ± 6.60 (p value < 0.0001). The range of motion in the hip, knee, and ankle joints was reduced compared to that of individuals in the same age group without pain. Specifically, Hip extension-adduction, knee extension, and ankle plantarflexion-inversion-eversion had a p value of <0.0001. For hip flexion-abduction-medial and lateral rotation, knee flexion, and ankle dorsiflexion, the p values were 0.0003, 0.1952, 0.0001, 0.003, 0.0392, and 0.0333. Additionally, 35% of women had quadriceps angles greater than 180 degrees, while the remaining 65% had angles less than 180 degrees. 63% of women exhibited crepitus during activities like stair climbing and walking. 52% of women tested positive on the Waldron Test. 60% of women showed positive findings on the Eccentric Step-down Test. Conclusion: It concluded that there is significant Patellofemoral Joint Dysfunction in obese postmenopausal women.

Efficacy of hip abductors exercise training combined with repetitive transcranial magnetic stimulation on knee osteoarthritis: A randomized controlled trial.

Knee osteoarthritis is a common degenerative joint disease where a single treatment method often fails to fully alleviate symptoms. Hence, finding effective non-invasive combined treatment approaches is particularly crucial. The efficacy of treating knee osteoarthritis with hip abductors exercise training combined with repetitive transcranial magnetic stimulation was assessed through functional scales and objective evaluation methods. In this four-week randomized clinical trial, 160 patients meeting inclusion criteria were randomly assigned 1:1 to group A to receive oral celecoxib and group B to receive a combination of hip abductors exercise training and repeated transcranial magnetic stimulation. The primary outcome was the western Ontario and McMaster universities osteoarthritis index. The secondary outcomes include Visual Analogue Scale, knee outcome survey activities of daily living scale, Active Range of Motion, and the Quadriceps Angle, the tibiofemoral angle, peak adductor moment, the integrated electromyography and root mean square of the surface electromyography of the lower extremity muscles. Paired sample t test was used for Within-Group comparison of outcome indicators, and independent sample t test was used for Between-Group comparison. Of the 160 randomly assigned patients, 150 completed the study. After 4 weeks, the WOMAC index decreased from 61 ± 10.83 to 40.55 ± 7.58 in the combined treatment group and from 60.97 ± 10.18 to 47.7 ± 10.13 in the celecoxib group. The effect of the combined treatment group was significantly higher than that in the celecoxib group (P< 0.001). In the combined treatment group, the score of knee joint daily living scale increased (P< 0.001), the active range of motion increased (P< 0.001), the quadriceps angle decreased (P< 0.001), the tibiofemoral angle increased (P< 0.001), and the peak adduction moment decreased (P< 0.001), integrated electromyography and root mean square increased (P< 0.001), and the effect was better than that of celecoxib group (P< 0.001). The visual analog scale score in celecoxib group was lower (P< 0.001) and knee outcome survey activities of daily living scale was higher (P< 0.001). The incidence of treatment-related adverse events was 10% in the celecoxib group and 2.5% in the combined treatment group, all of which were mild. Hip abductors exercise training combined with repetitive transcranial magnetic stimulation can enhance abduction muscle strength, improve mobility, reduce joint pain, and enhance quality of life. This combined approach shows superior clinical effectiveness compared to oral celecoxib.

Exploring the complex interplay: Correlation between pronated foot and pelvic inclination, femoral anteversion, quadriceps angle, tibial torsion and talus head position in asymptomatic adults

Exploring the complex interplay: Correlation between pronated foot and pelvic inclination, femoral anteversion, quadriceps angle, tibial torsion and talus head position in asymptomatic adults

Radiological Verification for the Suitability of Using the Quadriceps Angle to Represent Orientation of the Quadriceps Femoris.

The orientation of the quadriceps femoris can be represented by the quadriceps angle (Q-angle) has not yet been approved because of the high incidence of patellar instability. In this study, the correlations among components of the quadriceps femoris and the Q-angle using the plain radiographic technique were assessed. This retrospective study aims to use the radiographic technique to clarify these doubts from anatomic viewpoints. One hundred consecutive young adult patients (50 men and 50 women; aged, 34 ± 5 and 33 ± 6 years, respectively) who sustained chronic unilateral lower extremity injuries (unilateral femoral, tibial nonunions or malunions) were enrolled. The contralateral intact lower extremity was used for the study. The full-length standing scanogram (FLSS) was used to evaluate the rectus Q-angle (R-Q angle), vastus Q-angle (V-Q angle), and clinical Q-angle (C-Q angle; i.e., known as the Q-angle). The three Q-angles were compared statistically. The Mann-Whitney U test and the Kruskal-Wallis test were used for comparison among groups. The Spearman rank correlation coefficient was used to evaluate the degree of relationship between two groups. The C-Q angle or the V-Q angle was statistically different from the R-Q angle (p < 0.001). The C-Q angle between sexes was not different (p = 0.25). High correlation occurred among the C-Q angle, the R-Q angle, and the V-Q angles (correlation coefficient, 0.886-0.979). The multiple linear regression revealed of C-Q angle = 0.72; R-Q angle, p < 0.001 + 0.21; and V-Q angle, (p = 0.009) + 2.61° in 100 patients. Orientation of the quadriceps femoris can be represented by the Q-angle. Compared to the rectus femoris, the three vastus muscles of the quadriceps femoris are more correlated to the Q-angle.

Evaluation of the relationship between the anatomical characteristics of the vastus medialis obliquus muscle and the patella chondral lesion occurrence.

The study aims to investigate the relationship between the vastus medialis obliquus (VMO) muscle distal insertion features and patellar chondral lesion presence. This cross-sectional study included a total of 100 patients (18 males, 82 females, mean age 67.2±7.1 years; range, 50 to 86 years) who underwent total knee arthroplasty (TKA). Radiological assessments, including merchant view and standing orthoroentgenograms, were conducted. The current osteoarthritis stage, varus angle, quadriceps angle (Q angle), patella-patellar tendon angle (P-PT angle), congruence angle, and sulcus angle were calculated. The VMO tendon length, muscle fiber angle, tendon insertion width measurements, and patellar chondral lesion localization data were obtained intraoperatively. Grouping was done according to the distal insertion width of the VMO tendon to the medial edge of the patella. The medial rim of the patella was divided into three equal-sized sectors. The first group (Group 1, n=31) consisted of patients who had an insertion from the quadriceps tendon into the upper one-third of the patella. The second group (Group 1, n=48) consisted of patients with a distal insertion expanding into the middle one-third of the patella. The third group (Group 3, n=21) consisted of patients who had a distal insertion extending into the distal third region of the medial patella margin. The patella joint surface was divided into sectors, and the presence and location of cartilage lesions were noted in detail. The mean tendon insertion width rate was 45.99±16.886% (range, 16.7 to 83.3%). The mean muscle fiber insertion angle was 51.85±11.67º (range, 20º to 80º). The mean tendon length was 12.45±3.289 (range, 4 to 20) mm. There was no significant difference between the mean age, weight, height, body mass index, BMI, fiber angle, tendon length, varus angle, Q angle, sulcus angle, and congruence angle data among the groups. In terms of the P-PT angle, Groups 1 and 2 had a significant relationship (p=0.008). No relationship was found between the mean fiber insertion angle, mean tendon length, or the presence of chondral lesions. There was a statistically significant difference among the groups regarding the presence of chondral lesions. The highest percentage of chondral lesion frequency was observed in Group 3 (95.24%), followed by Group 1 (90.3%) and Group 2 (89.6%), respectively. Compared to the other two groups, Group 3 had a higher average ratio of lesion areas per patient. Our study results demonstrate that the formation and localization of the patellar chondral lesions are affected by the insertion width type of the VMO muscle into the patella. Group 2-type insertion is associated with a lower lesion frequency rate than Groups 1 and 3.

Anterior Knee Pain (AKP) and its Relationship to Quadriceps Angle and Anthropometric Parameters: A Hospital-Based Cross-Sectional Study from Iraq

Abstract Background: Anterior knee pain (AKP) is a common condition, especially among physically active adults who present a clinical challenge. Patellar malalignment is thought to be an important cause. Measuring quadriceps (Q) angle significant test used in the assessment of patellar alignment and hence used in the assessment of AKP. Objectives: To assess the relationship between AKP and Q angle among ample Iraqi patients. Materials and Methods: The right and left Q angles of 100 participants were measured using a universal goniometer. The participants were divided into three groups: controls, patients with left AKP (LAKP), and patients with right AKP (RAKP). The relationship between Q angles and different groups was tested using appropriate statistical tests. Results: The left Q angles for males measure 14.1 ± 1.9 in controls, 17.7 ± 1.6 in LAKP cases and 16.1 ± 1.8 in RAKP cases, and for the females 16.1 ± 1.8 in controls, 18.1 ± 1.8 in LAKP cases and 17.1 ± 2.5 in RAKP cases. The right Q angles for males measure 15.6 ± 2.2 in controls, 15.1 ± 2.7 in LAKP cases and 19 ± 1.6 in RAKP cases, and for the females were 17.7 ± 2.4 in controls, 17.9 ± 2.2 in LAKP cases and 19.9 ± 2 in RAKP cases. Both Q angles (right and left) were greater in females than in males and both were greater in cases than in controls. Conclusion: The study concluded that there is a significant association between AKP and quadriceps femoris angle measurement in both genders. Therefore, clinical and/or radiological demonstration of quadriceps angle can be used as a means for initial detection of AKP.

Changes in dynamic quadriceps angle in patients with chronic ankle instability

Background: Changes in dynamic Quadriceps Angle (Q angle) had been studied in healthy subjects and individuals with other musculoskeletal disorders; however, in chronic ankle instability (CAI), it has not yet been determined. The purpose of this study was to investigate the difference in dynamic Q angle of patients with unilateral chronic ankle instability and those without chronic ankle instability. Methods: One-hundred and four participants with and without chronic ankle instability from both genders aged between 18-30 years, with a BMI range of 17.9-27.3, were enrolled into 2 equal groups; a study group and a control group, with mean values of age of the study and control groups (20.8±2.4) and (20.9±3) years respectively and of BMI (24.1±4.3) and (23.8±2.9) kg/m2 respectively. Dynamic Q angle measurement is carried out using dynamic knee valgus (DKV) through the frontal plane projection angle (FPPA) during single limb squat. Results: A statistically significant difference in FPPA angle was observed between the affected limb of the CAI group and controls (P=0.001). Conclusion: The present study suggested that unilateral CAI display an increased knee valgus, suggesting an additional proximal kinematic alteration and chronic maladaptation in the CAI population.

Reliability and validity of a smartphone goniometer application for measuring the quadriceps angle in healthy women: a cross-sectional study

Background/Aims The quadriceps angle, which depicts the quadriceps muscle's mechanical effect on the knee, is frequently used as an assessment metric when diagnosing a variety of knee-related issues. Smartphone goniometer applications have clinical assessment capabilities that can be used instead of the universal goniometer. The aim of this study was to analyse the criterion validity and inter- and intra-rater reliability of a smartphone goniometer application for measuring the quadriceps angle. Methods A total of 50 typically healthy women were included in this study. The quadriceps angle was evaluated with the universal goniometer as the gold standard and the Angulus smartphone goniometer application on each participant. The intraclass correlation coefficient and 95% confidence intervals were used to analyse reliability, while the standard error of the mean was used to calculate precision. Bland-Altman plots and 95% limits of agreement were used to establish the levels of agreement between the smartphone goniometer application and the universal goniometer. The Pearson correlation coefficient was used to quantify the smartphone goniometer application criterion validity in comparison to the universal goniometer. Results The smartphone goniometer application had good intra-rater reliability (intraclass correlation coefficient 0.99; 95% confidence interval 0.96–1) and inter-rater reliability (intraclass correlation coefficient 0.98; 95% confidence interval 0.94–1). A strong and significant correlation was found between the universal goniometer and the smartphone goniometer application, showing good criterion validity (r=0.99; 95% confidence interval 0.98–0.99; P=0.006). Conclusions The use of the smartphone goniometer application to measure the quadriceps angle was valid and demonstrated excellent intra- and inter-rater reliability levels. Implications for practice The smartphone goniometer application can be used in clinical practice as a valid and reliable quadriceps angle measurement tool.

A Critical Analysis of the Factors Contributing to Anterior Cruciate Ligament Injuries in Female Athletes.

Anterior Cruciate Ligament (ACL) injuries are a prevalent concern in athletic population, particularly among female athletes who are disproportionately affected. The increased incidence of ACL injuries in females is attributed to a combination of anatomical, physiological, and biomechanical factors that influence knee stability. This review comprehensively explores these contributing factors, highlighting gender-specific anatomical differences such as wider pelvis, increased quadriceps (Q) angle, and steeper tibial slopes, all of which predispose females to greater knee valgus during dynamic activities. Furthermore, hormonal influences and greater ligament laxity are discussed as physiological contributors to increased ACL injury risk. Biomechanical factors such as reduced knee flexion, increased knee valgus, and altered muscle activation patterns further amplify the risk of ACL tears in female athletes. Despite extensive research, gaps remain in the understanding of how these factors interact and influence injury susceptibility. This article is focussed on the critical points in the current literature, analyzing key risk factors, and identifying future research directions that can inform more effective prevention strategies. A better understanding of these factors will ultimately contribute to reducing the incidence of ACL injuries among female athletes and improving long-term strength and stability of knee joint.

Association of Quadriceps Angle (Q Angle) with Gender, Anthropometric Measurements and Quadriceps Muscle Strength in Healthy Young Adults

&#x0D; Background: Quadriceps angle is the angle produced between the quadriceps muscle and the patellar tendon, which is also known as Q angle. It is also regarded as a key component for the correct knee posture and movement. Q angle is frequently employed as a diagnostic indicator for knee-related issues such as anterior knee pain, degenerative knee disorders, osteoarthritis etc. It has a great clinical and biomechanics significance and this angle gives useful information about alignment of lower limb. Present study shows association of Q angle with gender, various anthropometric measurements and Quadriceps muscle strength. Methods: Total 150 healthy young individuals (20 male and 130 female) between the age of 18 to 30 years from the different constituent institutes of Sumandeep Vidyapeeth University were included in the study. Q angle was measured in degrees by using universal goniometer on both sides. Anthropometric measurements - Height, weight. Body mass index, Waist and Hip circumference, Intercondylar distance between femur and Quadriceps muscle strength were measured. Results: In this study, the correlation between Q angle and Anthropometric measurements were analyzed. The mean Q angle on right side was 18.87 and on left side was 18.87. Bilaterally, no significant differences were found in Q angle. The angle of right and left side was significantly correlated with weight, height, BMI, intercondylar distance and quadriceps muscle strength. However, these angles are not correlated with WHR. Conclusion: This study supported positive correlation of weight and BMI with Q angle; negative correlation of height, intercondylar distance of femur and quadriceps muscle strength with Q angle. Although, no significant correlation was found between Q angle and WHR.

Comparison of Static Lower Extremity Alignment in Female Ballet Dancers and Non-ballet Dancer

PURPOSE This study aimed to: 1) compare the differences in static lower-extremity alignment (SLEA) between female ballet dancers (BD) and non-ballet dancers (NBD); 2) investigate the differences among gesture leg (GL) and supporting leg (SL) in BD and dominant leg (DL) in NBD; and 3) compare limb asymmetry between groups.METHODS Twenty-nine female BD and 20 NBD were recruited for this study. The quadriceps, tibiofemoral, rearfoot, and genu-recurvatum angles, tibial torsion and varum, and navicular drop height were measured. An independent &lt;i&gt;t&lt;/i&gt;-test was conducted to compare SLEA and limb asymmetry between groups. One-way analysis of variance with Bonferroni post-hoc tests were performed to determine the differences among the GL, SL and DL.RESULTS BD showed lower quadriceps and rearfoot angles, less tibial varum and navicular drop, and greater tibiofemoral angle (&lt;i&gt;p&lt;/i&gt;&lt;.005) than NBD. BD showed less quadriceps angle asymmetry but greater tibial torsion asymmetry (&lt;i&gt;p&lt;/i&gt;&lt;.01) than NBD. GL and SL in BD showed differences in quadriceps, tibiofemoral, rearfoot angle, tibial torsion and navicular drop compared to NBD.CONCLUSIONS Repetitive dance movements can transfer varying forces to the GL and SL, potentially contributing to SLEA asymmetry. An intervention strategy that can reduce SLEA asymmetry in BD is needed, as is the identification of elements of ballet training that contribute to maintaining a normal SLEA.

Risk Factors for Concomitant Meniscal Injury With Sport-Related Anterior Cruciate Ligament Injury.

Previous studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors. To identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury. Cross-sectional study; Level of evidence, 3. This study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted. Concomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci. Measures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.

Quadriceps Angle Measurement in Adolescents With Short Stature: Exploring the Relationship Between Postural Alignment and Lower Limb Mechanics.

Background The quadriceps angle (Q angle) is measured as an angle formed by two lines that extend from the anterior superior iliac spine to the midpoint of the patella and from the midpoint of the patella to the tibial tuberosity. The average Q angle value for children aged between seven to 12 years was 13.1˚±3.5˚in boys and 13.7˚±4.9˚ in girls, whereas 8˚-15˚ in men and 12˚-19˚ in women. Abnormal variation in Q angle is associated with patellofemoral pain syndrome, lateral patellar malposition, dislocation, chondromalacia patella, patella alta, genu varum, etc. Methodology The present study explores the status of Q angle values among adolescents with short stature and their comparison with age and gender-matched children between 10 and 15 years of age. Results We found a statistically significant difference between the Q angle value in the control group and the male with short stature group aged 14-15 years, with a mean difference of 3.7˚. However, among females, there was a significant difference between the control group and the short-stature group aged 12-13 and 14-15 years, with a mean difference of 2.8˚ and 2.5˚, respectively. Implications Early detection and timely remedial measures, e.g., quadriceps strengthening exercises, before skeleton maturity can prevent Q angle-related misalignments and abnormalities in the limb.

The relationship between flat foot and Q-angle in elementary school students

Background: Elementary school students have unique characteristics. Each child has their ways of doing their activities. In its activities, of course, there are risks, especially in the lower extremities, namely flat foot, which is the condition of the medial arch treading with the ground or flat due to emphasis on the medial part, excessive or over foot conditions will result in an increase in valgus shape in the knee joint; thus the degree of quadriceps angle (Q-angle) can increase. This study aims to determine the relationship between flat foot and Q-angle in elementary school children in Kusamba Village, Dawan District, Klungkung Regency.&#x0D; Objective: This study aims to determine the relationship between flat feet and Q-angle.&#x0D; Methods: Observational analytical cross-sectional design that uses simple random sampling techniques with a sample of 51 people according to predetermined inclusion and exclusion criteria. Data were collected with a wet footprint test and Clark's angle to find a flat foot and Q-angle with a 360o goniometer.&#x0D; Results: The analysis test results obtained a result of p=0.000 (p&lt;0.05), so it can be explained that there is a significant relationship between flat foot and Q-angle. The results of the spearmen-rho analysis obtained a moderate relationship with the value of the correlation coefficient on the right flat foot with a right Q-angle of 0.527 and the left flat foot with a left Q-angle of 0.597 which means the direction of the relationship is unidirectional.&#x0D; Conclusion: Based on the study's results, it can be concluded that there is a moderate, unidirectional, and meaningful relationship between flat foot and Q-angle in elementary school children in Kusamba Village, Dawan District, Klungkung Regency.

Poster 245: Clinical Measurement of the Standard Q-Angle Correlates Poorly with Tibial Tuberosity to Trochlear Groove Distance in Awake Patients and Anesthetized Patients with Patella Alta and Trochlear Dysplasia

Objectives: The quadriceps angle (Q-angle) measures the force vector of pull of the extensor mechanism of the knee. A larger Q-angle is thought to be a predisposing factor for patellar dislocation, but previous literature has reported poor reliability and validity of clinically measured Q-Angle. In response to poor reliability, a new “Standard Q-Angle” (SQA) was developed by Merchant et al. (Merchant 2020) in an attempt to create a standardized and repeatable method of clinically measuring the Q-Angle. The SQA may be a practical, inexpensive, and valuable part of physical examinations to help clinicians decide if concomitant medializing osteotomy is indicated in patellar stabilization procedures. However, SQA has not yet been validated in patients with anatomic risk factors for recurrent patellar instability such as patella alta and trochlear dysplasia. Furthermore, while SQA has previously been demonstrated to have strong interrater reliability, it has never been shown to correlate with standardized measurements for a lateralized tibial tuberosity, such as the Tibial Tuberosity – Trochlear Grove (TT-TG) distance. Therefore, the purpose of our study was to determine the correlation between SQA and TT-TG distance in patients with recurrent patellar instability. We hypothesized that there would be a positive correlation between SQA and TT-TG distance. 1. Merchant AC, Fraiser R, Dragoo J, Fredericson M. A reliable Q angle measurement using a standardized protocol. Knee. 2020;27(3):934-939. Methods: Patients at a single institution treated by a single surgeon with recurrent patellar instability who had previously obtained a dynamic 4D CT scan were included in this study. Patients who had previous patellar stabilization procedures were excluded. The Standard Q-angle was measured as previously described by Merchant et al. (Merchant 2020). The patient was placed in the supine position with the knee extended. A long-arm goniometer was centered over the patella with the distal arm over the tibial tuberosity and the proximal arm extended up to the anterior superior iliac spine (ASIS). The examiner then centered the patella within the trochlear groove and the SQA was measured. A second examiner stood at foot of the patient’s bed to confirm positioning. Measurements were taken in the office, as well as in the operating room after the induction of general anesthesia. All measurements were performed by the senior author (***). Utilizing 4D CT scans, the TT-TG, Caton-Deschamps index (CDI), and lateral trochlear inclination (LTI) were measured as previously described. Patients whose CDIs were between 0.8 and 1.2 were considered to have normal patellar height. Patients whose LTIs were &gt;11° were considered to have normal LTI, which has been shown to have a sensitivity of 93% and a specificity 87% for detecting trochlear dysplasia. Mean and standard deviation values were calculated for patient demographic information, and correlation coefficients were calculated to compare SQA with TT-TG distance in both awake and anesthetized patients. The statistical software Stata was utilized for all analyses (StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX). Results: Fifty-seven patient knees were included in the study. The mean age was 22 years-old (±6 years). For awake patients, the correlation coefficient (R2) between SQA and TT-TG was -0.006 (Figure 1), and in anesthetized patients R2 = 0.093 (Figure 2). In the “normal patellar height” group, the R2 value was higher in the anesthetized group (R2 = 0.334) than the awake group (R2 = 0.239). In the normal lateral trochlear inclination group, there was also a greater R2 value in the anesthetized group (R2 = 0.403) than the awake group (R2 =0.093). The correlation between SQA and TT-TG was the strongest in anesthetized patients with both a CDI &lt; 1.2 and LTI &gt;11° (R2 = 0.635). Conclusions: There was a strong positive association between SQA and TT-TG in anesthetized patients with normal patellar height and a normal lateral trochlear inclination. However, in awake patients and patients with anatomic risk factors for recurrent patellar instability there was only a weak association between SQA and TT-TG. The SQA may be able to provide useful information, but only in selected cases. Therefore, it remains important to have objective radiographic measurements to characterize the position of the tibial tuberosity when planning patellar stabilization surgery.