Quadriceps Angle Research Articles

Adolescent patellar instability: current concepts review.

Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70.

Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

Knee pain without knee degenerative symptoms is a common phenomenon among young basketball players. The aim of this study was to identify factors predisposing young basketball players to suffer from knee pain. The study involved 20 male adolescent (14-15 years) basketball players who were divided into two equal groups based on knee pain symptoms. Legs torque was tested on an isokinetic dynamometer. The length, elongation and the cross-sectional area (CSA) of the patellar tendon were measured with ultrasonography. Quadriceps angle (Q-angle), knee valgus motion, and joint angular displacement in the sagittal plane were analyzed using video recording during countermovement jump. Ground reaction force was measured using a force platform. Knee pain (KP) participants had a significantly lower Q-angle (P=0.045) and lower maximum varus knee angle (P=0.035), and a greater knee inside displacement (P=0.039) during squat phase. In the KP group, the CSA at the top of the tendon was significantly greater than in the middle (P=0.006) and at the bottom (P=0.039). Absolute tendon stiffness (P=0.013) and Young's modulus (P=0.034) were significantly lower in the KP group compared with controls. Leg stiffness during landing was significantly greater in the control group (P=0.015). Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes.

[Purpose] To investigate the gender-related differences in lower limb alignment, range of joint motion, and history of lower limb sports injuries in Japanese university athletes. [Subjects and Methods] The subjects were 224 Japanese university athletes (154 males and 70 females). The quadriceps angle (Q-angle), arch height index, and ranges of internal and external rotation of the hip joints were measured. History of lower limb sports injury was surveyed using a questionnaire. [Results] Females had a significantly higher Q-angle and hip joint internal rotation angle and a significantly lower arch height index than males. The survey revealed that a significantly higher proportion of females had a history of lower limb sports injuries, and that the proportion of those with a history of foot/ankle injuries was particularly high. [Conclusion] These results suggested that females experience more lower limb sports injuries than males, and that a large proportion of these injuries involve the foot/ankle. Reduced lower limb alignment and increased range of joint motion in females may be risk factors for injury because they lead to increased physical stress being exerted on the lower legs during sporting activities.

Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types

AimThe aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types. MethodsThirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software. ResultsAll measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79–0.93) and normal feet type (ICC: 0.84–0.97) groups. ConclusionThe findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups.

Investigation of the Relationship Between Flatfoot and Patellar Subluxation in Adolescents

Patellar subluxation is common in adolescents, and a variety of factors are related to this condition, with valgus of the knee joint an important factor. The results of many studies suggest that flatfoot can cause an abnormality of the lower limb power line. Structural abnormalities of the foot caused by the high stresses exerted by body weight can lead to structural deformity of the knee and can also cause knee valgus. Screening for foot problems can help determine the risk of patellar subluxation, and early intervention can lessen the incidence of this condition. The purpose of the present study was to investigate the effects of flatfoot on the structure and function of the knees and, especially, the risk of patellar subluxation. A total of 72 participants were recruited for this cross-sectional study. The mean age at examination was 15.4 ± 4.0 (range 9 to 22) years. The measured parameters were heel valgus angle, arch index, and quadriceps angle (Q-angle). Overall, the mean values of the heel valgus angle, arch index, and Q-angle were 5.9° ± 2.4° (range 1° to 11°), 0.33 ± 0.07 (range 0.23 to 0.46), and 19.1° ± 3.5° (range 9° to 26°), respectively. The Q-angle was directly associated with the heel valgus angle (r = 0.818, p < .001) and arch index (r = 0.655, p < .001). We found that flatfoot can affect the morphology of the knee joint and increase the risk of patellar subluxation.

Intraarticular Giant Size Angiolipoma of the Knee Causing Lateral Patellar Dislocation.

Angiolipomas are benign tumors usually seen in patients during their 2nd and 3rd decades. The subcutaneous region of the trunk, neck and extremities are the places where they generally settle. There is only one case report on angiolipoma in the knee joint that was resected by arthroscopic procedure in the English literature. We present a case of a giant-size multilobular non-infiltrating angiolipoma, extending outside of the right knee joint and causing lateral patellar dislocation in a thirteen-year-old boy. A large encapsulated mass with fatty and soft-tissue components on magnetic resonance imaging was suggestive of a liposarcoma. However, the diagnosis after the tru-cut biopsy was angiolipoma. The Quadriceps angle was 25°. Complete resection of the tumoral mass and repair of the medial retinaculum were performed with open surgery. Patellofemoral alignment was provided by transferring the tibial tuberosity medially. One year after the surgery, there was no evidence of recurrence. Intra-articular angiolipomas are rarely seen masses in the knee joint. To our knowledge, this case report is the first to demonstrate that angiolipoma causes patellar dislocation.

Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review.

What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)? The authors performed a literature search of CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from each database's inception to July 2013. The following key words were used together or in combination: armed forces, athlete, conditioning, disorder predictor, exercise, medial tibial stress syndrome, militaries, MTSS, military, military personnel, physically active, predictor, recruit, risk, risk characteristic, risk factor, run, shin pain, shin splints, and vulnerability factor. Studies were included in this systematic review based on the following criteria: original research that (1) investigated risk factors associated with MTSS, (2) compared physically active individuals with and without MTSS, (3) was printed in English, and (4) was accessible in full text in peer-reviewed journals. Two authors independently screened titles or abstracts (or both) of studies to identify inclusion criteria and quality. If the article met the inclusion criteria, the authors extracted demographic information, study design and duration, participant selection, MTSS diagnosis, investigated risk factors, mean difference, clinical importance, effect size, odds ratio, and any other data deemed relevant. After the data extraction was complete, the authors compared findings for accuracy and completeness. When the mean and standard deviation of a particular risk factor were reported 3 or more times, that risk factor was included in the meta-analysis. In addition, the methodologic quality was assessed with an adapted checklist developed by previous researchers. The checklist contained 5 categories: study objective, study population, outcome measurements, assessment of the outcome, and analysis and data presentation. Any disagreement between the authors was discussed and resolved by consensus. A total of 165 papers were initially identified, and 21 original research studies were included in this systematic review. More than 100 risk factors were identified in the 21 studies. Continuous data were reported 3 or more times for risk factors of body mass index (BMI), navicular drop, ankle plantar-flexion range of motion (ROM), ankle-dorsiflexion ROM, ankle-eversion ROM, ankle-inversion ROM, quadriceps angle, hip internal-rotation ROM, and hip external-rotation ROM. As compared with the control group, significant risk factors for developing MTSS identified in the literature were (1) greater BMI (mean difference [MD] = 0.79, 95% confidence interval [CI] = 0.38, 1.20; P < .001), (2) greater navicular drop (MD = 1.9 mm, 95% CI = 0.54, 1.84 mm; P < .001), (3) greater ankle plantar-flexion ROM (MD = 5.94°, 95% CI = 3.65°, 8.24°; P < .001), and (4) greater hip external-rotation ROM (MD = 3.95°, 95% CI = 1.78°, 6.13°; P < .001). Ankle-dorsiflexion ROM (MD = -0.01°, 95% CI = -0.96, 0.93; P = .98), ankle-eversion ROM (MD = 1.17°, 95% CI = -0.02, 2.36; P = .06), ankle-inversion ROM (MD = 0.98°, 95% CI = -3.11°, 5.07°; P = .64), quadriceps angle (MD = -0.22°, 95% CI = -0.95°, 0.50°; P = .54), and hip internal-rotation ROM (MD = 0.18°, 95% CI = -5.37°, 5.73°; P = .95), were not different between individuals with MTSS and controls. The primary factors that appeared to put a physically active individual at risk for MTSS were increased BMI, increased navicular drop, greater ankle plantar-flexion ROM, and greater hip external-rotation ROM. These primary risk factors can guide health care professionals in the prevention and treatment of MTSS.

Do Lower-Body Dimensions and Body Composition Explain Vertical Jump Ability?

Caia, J, Weiss, LW, Chiu, LZF, Schilling, BK, Paquette, MR, and Relyea, GE. Do lower-body dimensions and body composition explain vertical jump ability? J Strength Cond Res 30(11): 3073-3083, 2016-Vertical jump (VJ) capability is integral to the level of success attained by individuals participating in numerous sport and physical activities. Knowledge of factors related to jump performance may help with talent identification and/or optimizing training prescription. Although myriad variables are likely related to VJ, this study focused on determining if various lower-body dimensions and/or body composition would explain some of the variability in performance. Selected anthropometric dimensions were obtained from 50 university students (25 men and 25 women) on 2 occasions separated by 48 or 72 hours. Estimated body fat percentage (BF%), height, body weight, hip width, pelvic width, bilateral quadriceps angle (Q-angle), and bilateral longitudinal dimensions of the feet, leg, thigh, and lower limb were obtained. Additionally, participants completed countermovement VJs. Analysis showed BF% to have the highest correlation with countermovement VJ displacement (r = -0.76, p < 0.001). When examining lower-body dimensions, right-side Q-angle displayed the strongest association with countermovement VJ displacement (r = -0.58, p < 0.001). Regression analysis revealed that 2 different pairs of variables accounted for the greatest variation (66%) in VJ: (a) BF% and sex and (b) BF% and body weight. Regression models involving BF% and lower-body dimensions explained up to 61% of the variance observed in VJ. Although the variance explained by BF% may be increased by using several lower-body dimensions, either sex identification or body weight explains comparatively more. Therefore, these data suggest that the lower-body dimensions measured herein have limited utility in explaining VJ performance.

Relationship of Knee Motions With Static Leg Alignments and Hip Motions in Frontal and Transverse Planes During Double-Leg Landing in Healthy Athletes.

Excessive knee valgus and tibial external rotation relative to the femur during weight bearing motions, such as jump-landing, reportedly increases the risk of developing chronic knee pain, such as patellofemoral pain. Excessive deviations from normal ranges of several static lower extremity alignment measures and dynamic hip motions may also increase the risks for patellofemoral pain. To determine the relationship between lower extremity alignments and hip motions to frontal and transverse plane knee motions during double-leg landings. Correlational study. Laboratory. 69 healthy, competitive athletes (27 men, 42 women; height, 166.5 ± 9.5 cm; weight, 61.3 ± 9.9 kg; age, 20.7 ± 1.0 y) participated in this study. Prone and supine hip version, quadriceps angle, and tibiofemoral angle were measured. Frontal and transverse knee and hip angles at peak knee extensor moment during landing were calculated. 2 separate stepwise multiple regression analyses were conducted to predict frontal and transverse plane knee motions using 4 static lower extremity alignment measures and hip motions. Greater hip adduction and prone hip anteversion, and lesser hip internal rotation and supine hip anteversion, were related to greater knee valgus motions (R2 = .475, P < .01). Greater hip adduction was related to greater knee external rotation (R2 = .205, P < .01). Some targeted static lower extremity alignments and hip motions are associated with frontal and transverse knee motions. However, stronger relationships of hip motions with knee motions than static lower extremity alignments provided evidence that improving hip movements may help improve patellofemoral pain in those with lower extremity malalignments.

Consistency of Lower-Body Dimensions Using Surface Landmarks and Simple Measurement Tools.

Caia, J, Weiss, LW, Chiu, LZF, Schilling, BK, and Paquette, MR. Consistency of lower-body dimensions using surface landmarks and simple measurement tools. J Strength Cond Res 30(9): 2600-2608, 2016-Body dimensions may influence various types of physical performance. This study was designed to establish the reliability and precision of bilateral lower-body dimensions using surface anatomic landmarks and either sliding calipers or goniometry. Fifty university students (25 men and 25 women) were measured on 2 separate occasions separated by 48 or 72 hours. A small digital caliper was used to acquire longitudinal dimensions of the feet, whereas a larger broad-blade caliper was used to measure lower-limb, hip, and pelvic dimensions. Quadriceps angle (Q-angle) was determined through surface goniometry. Data for all foot and lower-limb dimensions were both reliable and precise (intraclass correlation coefficient (ICC) ≥0.72, SEM 0.1-0.5 cm). Measures of Q-angle were also reliable and precise (ICC ≥0.85, SEM 0.2-0.4°). Findings from this investigation demonstrate that lower-body dimensions may be reliably and precisely measured through simple practical tests, when surface anatomic landmarks and standardized procedures are used. Although intertester reliability remains to be established, meticulous adherence to specific measurement protocols is likely to yield viable output for lower-body dimensions when more sophisticated methods are unavailable or inappropriate.

Pathogenesis of Fifth Metatarsal Stress Fractures in College Soccer Players

Category: Sports Introduction/Purpose: The pathogenesis of fifth metatarsal stress fractures remains uncertain. We hypothesized that physical characteristics and environmental factors, which have received limited attention in the literature thus far, might be involved in the development of such fractures. To test our hypothesis, we performed a medical checkup and a survey of the living environment of athletes in college soccer teams, and subsequently, we investigated the existence of fifth metatarsal stress fractures, and examined the differences between the injury group and the non-injury group. Methods: The survey and measurements were conducted in 273 male athletes from the same college soccer team between 2005 and 2013. A medical checkup, comprising assessment of stature, body weight, body mass index, arch height ratio, toe-grip strength, quadriceps angle, leg-heel angle, functional reach test, one-leg standing time with eyes closed, straight leg raise test, finger-floor distance, heel-to-buttock distance, ankle joint range of motion, and general joint laxity test, and a questionnaire survey were performed once a year. A survey was conducted at the time of injury that resulted in fifth metatarsal stress fractures. The study participants were separated into an injury group and a non-injury group, depending on whether they had a fifth metatarsal stress fracture. The measurement items and survey items were compared, and the association between the presence or absence of injury and the measurement items was analyzed. Results: Toe-grip strength was significantly weaker in the injury group, compared with the non-injury group, suggesting that a weak toe-grip is associated with fifth metatarsal stress fracture (p &lt; 0.05). In addition, injury on the non-dominant leg was more frequent in the fifth metatarsal stress fracture injury group (p &lt; 0.05). Between-group comparisons of the other items showed no statistically significant differences. Conclusion: The association between weak toe-grip strength and fifth metatarsal fracture suggests that a weak toe-grip may lead to an increase in the load applied onto the lateral side of the foot; this may cause mechanical stress on the bone. In addition, the effect of the non-dominant leg on the fifth metatarsal bone may need to be studied further.

The evaluation of the combined grices method for the treatment of severe flatfeet

The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types.Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software.All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79–0.93) and normal feet type (ICC: 0.84–0.97) groups.The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups.

Korean Males And Females Demonstrate Similar Construct Of Lower Extremity Characteristics As Caucasian Males And Females

It has been reported that there are gender differences in lower extremity alignments (LEA). However, ethnic differences have not been examined. PURPOSE: To identify relationships among static LEA in Korean and the Caucasian males and females. METHODS: A total of 139 subjects [34 Korean males (age: 21.1±3.1yrs, height: 176.0±6.7cm, mass: 71.5±8.4 kg); 32 Korean females (age: 21.0±1.7yrs, height: 163.6±5.0cm, mass: 56.8±5.4kg); 39 Caucasian males (age: 33.8 ± 3.6yrs, height: 178.5±6.9cm, mass: 82.3±10.3kg); 34 Caucasian females (age: 31.7±2.8yrs, height: 164.9±6.7cm, mass: 67.1±16.2 kg)] participated. Eight static LEA [hip anteversion (AT), quadriceps angle (QA), tibiofemoral angle (TF), genu recurvatum (GR), rearfoot angle (RF), tibial torsion (TT), pelvic angle (PA), navicular drop (ND) were measured. Scree plot and factor analysis was conducted to examine the number of factors and relationships among static LEAs in each ethnic group. RESULTS: Categorization of factors and the Eigen values (EV) of factors in each group are as follows: In Caucasian males, the first factors (EV: 1.78) are ND [factor loading (FL): .84], and TF (FL: .69); the second factors (EV: 19.90) are PA (FL: .77), QA (.74), and TT (.46); the third factors (EV: 16.17) are GR (FL: .75), AT (FL: .63) and RF (FL: .56). In Caucasian females, the first factors (EV: 1.70) are ND (.80) and GR (.71); the second factors (EV: 1.70) are TT (FL: .73), RF (FL: -.63), QA (FL: .63) and AT (FL: .63); the third factors (EV: 1.51) are PA (FL: .79) and TF (FL: .73). In Korean males, the first factors (EV: 1.95) are PA (FL: .79), QA (FL: .65), TF (FL: .58) and GR (FL: -.53); the second factors (EV: 1.45) are RF (FL: -.87) and ND (FL: .65); the third factors (EV: 1.39) are AT (FL: -.77) and TT (FL: .71). In Korean females, the first factors (EV: 1.78) are ND (FL: -.82), RF (FL: .77) and TT (FL: .66); the second factors (EV: 1.66) are QA (FL: .88) and TF (FL: .82); the third factors (EV: 1.50) are AT (FL: -.78), GR (FL: .55) and PA (FL: .54). CONCLUSIONS: Similar categorization characteristics in QA, TF, ND, and RF in Korean males and females indicate that Korean males and females demonstrated similar LEA characteristics. These results were not found in Caucasian males and females. Therefore, it is suggested to consider ethnic differences to investigating the relationship between LEA and risk of injury.

Sex Differences in Static Lower Extremity Alignment in Korean Collegiate Student

Lower extremity alignment (LEA) characteristics have been reported as potential risk factor that can cause ACL injuries during a variety of sports events. Even though there seems to be different relationship among LEA between male and female, gender difference in alignment however, has not been widely investigated in Korea. PURPOSE: To compare gender differences of static LEA in the Korean collegiate student. METHODS: A total of 66 subjects (34M: age = 21.1 ± 3.1 years, height = 176.0 ± 6.7 cm, mass = 71.5 ± 8.4 kg; 32F: age= 21.0 ± 1.7 years, height = 163.6 ± 5.0 cm, mass = 56.8 ± 5.4 kg) participated in this study. Seven static LEA [hip anteversion, quadriceps angle (Q-angle), rearfoot angle, tibial varum, tibial torsion, pelvic angle, navicular drop] were measured by a single investigator. All alignments were measured only on the dominant. Cohen’s effect size was calculated in order to identify the magnitude of differences. A confidence interval of 95% was calculated to find any significant differences. RESULTS: Females have a significantly greater Q-angle [M= 13.21° ± 3.76°, F=18.95° ± 4.14°, ES = -1.46 (CI: -2.41 to -0.5)]. Even though the results were not significantly different (moderate high effect size), females have greater hip anteversion [M=6.35° ± 6.88°, F=10.38° ± 6.06°, ES = -0.62 (-2.19 to 0.95)] than males, while males have a greater external rotational tibial torsion [M=21.03° ± 7.09°, F=16.59° ± 6.76°, ES = 0.64 (-1.03 to 2.31)]. CONCLUSIONS: In the case of Koreans, there was no anecdotal difference of ACL injury between the sexes. Based upon this study, the sex differences of static LEAs were only indicated in the Q-angles of the two sexes. In previous studies not only Q-angle but multiple LEA such as Tibiofemoral angle, WB Q-angle, anterior pelvic tilt, femoral anteversion, genu recurvatum were significantly different between male and female. Thus, further study is necessary to identify ethnic difference in LEA as well as any differences in dynamic alignment among different sexes. Sponsored by IOC Medical and Scientific Commission Research Center for Prevention of Injury and Promotion of Athletic Health Grant

Changes in Neuromuscular Performance throughout the Menstrual Cycle in Physically Active Females

PURPOSE: The purpose of this study was to determine the change in neuromuscular performance throughout the menstrual cycle in college-aged females and the effect of hormonal contraception on these changes. METHODS: Fifty physically active college females (25 on oral contraceptives (OC)) were recruited to participate in three visits throughout one menstrual cycle. Visits coincided with the follicular (Fp), ovulatory (Op), and the luteal (Lp) phases. Blood was drawn at each visit to determine circulating concentrations of estradiol (E2), progesterone (P4), and relaxin (R2). Grip strength, knee joint laxity, q-angle, and isokinetic quadriceps strength at 60°/sec, 180°/sec, and 300°/sec were measured. Data were analyzed using linear mixed effect models taking into account repeated measures. RESULTS: Grip strength was lower during Fp (30.1 ± 0.7 kg/m2) than during Op (31.5 ± 0.7 kg/m2, p=0.003) and Lp (32.6 ± 0.7 kg/m2, p<0.001). Isokinetic peak torque (IPT) at 60°/sec was lower during Fp (112 ± 3 ft-lbs) than during the Op (116 ± 3 ft-lbs, p=0.009). IPT at 180°/sec was lower during the Fp (73 ± 2.0 ft-lbs) than the Op (79 ± 2 ft-lbs, p<0.001) and Lp (82 ± 2 ft-lbs, p<0.001). Results were similar for the 300°/sec isokinetic testing with lower peak torque during Fp (58 ± 2 ft-lbs) than the Op (63 ± 2 ft-lbs, p<0.001) or Lp (63 ± 2 ft-lbs, p<0.001). No differences were observed among any of the visits for knee joint laxity, or quadriceps angle. The OC-by-phase interaction was not significant for any of the outcomes or R2 concentration, but was significant for E2 and P4 with the concentrations of E2 and P4 being lower during the ovulatory and luteal phases in the OC group. Inclusion of E2, P4 or R2 in statistical models did not affect any of the outcomes for either group. CONCLUSION: Results indicate that muscular performance is diminished during follicular phase (menstruation) and the lack of significant OC-by-phase interaction indicates that this effect is not related to OC use, E2 concentrations, or P4 concentrations. Based on these data we postulate that female athletes may be at a greater risk of injury due to decreased strength during Fp than other phases of their cycle; future studies should focus on attenuating the strength decrease observed during menstruation.

Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes

Background: Multivariate analysis that identifies the combination of risk factors associated with anterior cruciate ligament (ACL) trauma is important because it provides insight into whether a variable has a direct causal effect on risk or an indirect effect that is mediated by other variables. It can also reveal risk factors that might not be evident in univariate analyses; if a variable’s effect is moderated by other variables, its association with risk may be apparent only after adjustment for the other variables. Most important, multivariate analyses can identify combinations of risk factors that are more predictive of risk than individual risk factors. Hypothesis: A diverse combination of risk factors predispose athletes to first-time noncontact ACL injury, and these relationships are different for male and female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: Athletes competing in organized sports at the high school and college levels participated in this study. Data from injured subjects (109 suffering an ACL injury) and matched controls (227 subjects) from the same athletic team were analyzed with multivariate conditional logistic regression to examine the effects of combinations of variables (demographic characteristics, joint laxity, lower extremity alignment, strength, and personality traits) on the risk of suffering their first ACL injury and to construct risk models. Results: For male athletes, increases in anterior-posterior displacement of the tibia relative to the femur (knee laxity), posterior knee stiffness, navicular drop, and a decrease in standing quadriceps angle were jointly predictive of suffering an ACL injury. For female athletes the combined effects of having a parent who had suffered an ACL injury and increases in anterior-posterior knee laxity and body mass index were predictive of ACL injury. Conclusion: Multivariate models provided more information about ACL injury risk than individual risk factors. Both male and female risk models included increased anterior-posterior knee laxity as a predictor of ACL injury but were otherwise dissimilar.

The effect of high heels on quadriceps angle in adult females

Abstract Background & objectives: Shoes are no more mere accessories of the feet, but the essential part of a woman’s fashion that reflects her personality. As the high heel shoes have always been in fashion statements for women, many women going crazy about them, ignoring the postural effects that the shoes can create. The aim of this study to compare between the quadriceps angle at zero and 3-inch heel heights during the standing position in normal adult female. Methods: It is a case control study located in the Faculty of physical therapy at Kafrelsheikh University, between June to July 2015. Twenty-two adult females (age range 18-20 years) were selected randomly. The quadriceps angle was measured for all participants using radiographs in anteroposterior standing position at zero and 3-inch heel heights. Result: There was statistically significant increase in participant’s quadriceps-angle of the right or left knees (P 0.05) at zero and 3-inch heel heights. Conclusions: During standing position, the value of quadriceps angle was increased when the heel height was increased.

The patellofemoral joint alignment in patients with symptomatic accessory navicular bone

Quadriceps angle (Q angle) provides useful information about the alignment of the patellofemoral joint. The aim of the present study was to assess a possible link between malalignment of the patellofemoral joint and symptomatic accessory navicular (AN) bone as an underlying cause in early adolescence using Q angle measurements. This study was performed on patients presenting to the Foot and Ankle Clinic at the Jordanian Royal Medical Services because of pain on the medial side of the foot that worsened with activities or shoe wearing, with no history of knee pain, between September 2013 and April 2015. The Q angle was measured using a goniometer in 27 early adolescents aged 10-18 years diagnosed clinically and radiologically with symptomatic AN bone, only seven patients had associated pes planus deformity; the data were compared with age appropriate normal arched feet without AN. Navicular drop test (NDT) was used to assess the amount of foot pronation. The mean Q angle value among male and female patients with symptomatic AN with/without pes planus was significantly higher than in controls with normal arched feet without AN (p<0.05). Symptomatic AN feet were also associated with higher NDT values (p<0.001). The present findings suggest an early change in patellofemoral joint alignment in patients with symptomatic AN bone with/without arch collapse. Therefore, it is recommended that Q angle assessment should be an essential component of the examination in patients with symptomatic AN bone.

Normal Values of Quadriceps Angle and Its Correlation with Anthropometric Measures in a Group of Jordanians

Normal Values of Quadriceps Angle and Its Correlation with Anthropometric Measures in a Group of Jordanians

Predictor factors for lower extremity malalignment and non-contact anterior cruciate ligament injuries in male athletes.

The aim of this study was to determine the predictor factors concerning the lower extremity alignment in non-contact anterior cruciate ligament (ACL) injuries among male athletes. In a retrospective study, the unilateral navicular drop, the ankle dorsiflexion range of motion (ROM), internal tibia torsion, knee genu recurvatum, quadriceps angle, hip internal and external rotation ROM and hip anteversion were measured in 53 subjects with complete ACL injury and compared with these accepted standard values. To identify predictor factors for lower extremity alignment and non-contact ACL injuries in male athletes, a multiple logistic regression analysis method was performed. All the subjects were primarily assessed with activity modification and without an ACL reconstruction. The results of this study showed significant predictor correlations between the independent variables, ankle dorsiflexion, hip internal rotation and hip anteversion (p<0.05). However, the differences in navicular drop, internal tibia torsion, knee hyperextension, Q angle and hip external rotation were non-significant. According to these findings, a decreased ROM in ankle dorsiflexion, hip internal rotation and increased hip anteversion appeared to be statistically significant predictors for developing non-contact ACL ligament injuries in male athletes. Based on the results of this study, significant predictor factors between lower extremity alignment and ACL injuries are clinically relevant as it confirms the existence of increased injury risk with certain patterns of skeletal alignment. II.