Femorotibial Rotation and the Q-Angle Related to the Dislocating Patella

Sanfridsson, J.; Arnbjörnsson, A.; Fridén, Thomas; L, Ryd; Svahn, G.; Jonsson, Kjell

doi:10.1034/j.1600-0455.2001.042002218.x

Cited by 23 publications

(21 citation statements)

References 18 publications

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“…In contrast to general thought, the Q-angle is often decreased in cases with patellar lateralization. 5 Gait analysis in patients with chronic instability typically reveals quadriceps-avoiding gait with increased foot plantar-flexion, hyperextension of the knee without loading response and anterior shift of the centre of gravity (plantar-flexion–knee extension couple). A minority of patients display increased knee flexion during stance.…”

Section: Clinical Presentation and Examinationmentioning

confidence: 99%

“…However, there is poor correlation between clinical and radiographic measurements, and the Q-angle in dislocating knees may even be decreased. 5 True lateral radiographs allow classification of the type and degree of trochlear dysplasia, most commonly according to the principles stated by Déjour: shallow or missing sulcus (crossing sign), a flat or convex proximal sulcus or even a step-off between trochlea and anterior cortex of the distal femur and flattening of the lateral femoral condyle 16,17 (Fig. 2).…”

Section: Anatomical Considerations and Predisposing Factorsmentioning

confidence: 99%

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Patella instability in children and adolescents

Hasler

Studer

2016

EFORT Open Reviews

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Patellar instabilities are the most common knee pathologies during growth. Congenital dislocations are rare. Extensive, early soft tissue releases relocate the extensor mechanism and may enable normal development of the femoro-patellar anatomy.Conservative management is the preferred strategy after a ‘first-time’ traumatic dislocation. In cases with concomitant anatomical predisposing factors such as trochlear dysplasia, malalignment, malrotation or ligamentous laxity, surgical reconstruction must be considered. The same applies to recurrent dislocations with pain, a sense of instability or re-dislocations which may also lead to functional compensatory mechanisms (quadriceps-avoiding gait in knee extension) or cartilaginous lesions with subsequent patello-femoral osteoarthritis. The decision-making process guiding surgical re-alignment includes analysis with standard radiographs and MRI of the trochlear groove, joint cartilage and medial patello-femoral ligament (MPFL). Careful evaluation of dynamic and static stabilisers is essential: the medial patello-femoral ligament provides stability during the first 20° of flexion, and the trochlear groove thereafter.Excessive femoral anteversion, general ligamentous laxity with increased femoro-tibial rotation, patella alta and increased distance between the tibial tuberosity and the trochlear groove must also be taken into account and surgically corrected.In cases with ongoing dislocations during skeletal immaturity, soft tissue procedures must suffice: reconstruction of the medial patello-femoral ligament as a standalone procedure or in conjuction with more complex distal realignment of the quadriceps mechanism may lead to a permanent stable result, or at least buys time until a definitive bony procedure is performed.Cite this article: Hasler CC, Studer D. Patella instability in children and adolescents. EFORT Open Rev 2016;1:160-166. DOI: 10.1302/2058-5241.1.000018.

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Section: Clinical Presentation and Examinationmentioning

confidence: 99%

Section: Anatomical Considerations and Predisposing Factorsmentioning

confidence: 99%

Patella instability in children and adolescents

Hasler

Studer

2016

EFORT Open Reviews

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“…21 It is, therefore, possible that the presence of articular diseases generates motor adjustment patterns, in the standing position, which lead to reduced overloads on the involved joint and, consequently, are responsible for the lower than the expected Q-angle values. These fi ndings are similar to previously reported study, which analyzed the relationships between the Q-angle measures with patellar displacements, and observed that the healthy volunteers had higher Q-angles than the group of subjects with recurrent patellar displacements.…”

Section: Discussionmentioning

confidence: 99%

“…1 The prevalence of the knee OA, which gradually increases with age in women, but not in men, 3 reaches 12.1% in adults older than 60 years. 21 However, it is necessary to develop a theoretical basis to support the physical therapy assessments and the important outcomes to be adopted in the prognostic of patients with knee OA, since most of the studies associated Q-angle measurements with anterior knee pain only with the patellofemoral pain syndrome. 19 This suggests that the onset of knee OA fi rst occurs on the patellofemoral, followed by the tibiofemoral joint.…”

mentioning

confidence: 99%

Greater Q-Angle Measures Are Not Associated With Pain and Muscular or Functional Performance in Elderly Women With Knee Osteoarthritis

Peixoto

Dias

et al. 2013

Topics in Geriatric Rehabilitation

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Objectives:To compare and investigate the relationships between Q-angle values and measures of pain, muscular, and functional performances. Methods: Measures of Q-angles, pain, and muscular and functional performances were obtained in 30 elderly women with bilateral knee osteoarthritis. Pearson correlation coeffi cients were employed to evaluate relationships between the assessed variables ( P Ͻ .05). Results: Lower Q-angle values were found in the most symptomatic knee, but no statistically signifi cant correlations were found between the Q-angle and the other evaluated measures. Conclusions: Lower Q-angle values were found on the most symptomatic knee and they were not associated with pain, muscular, or functional performance.

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“…The Q‐angle involves intersecting lines of pull for the quadriceps femoris muscle group and the distal portion of the quadriceps femoris tendon inferior to the patella (patellar ligament). It has been assessed by radiographic imaging (ie, x‐ray, computed tomography scanning, and dual‐energy x‐ray absorptiometry) [4‐8], surface photographic imaging [9‐18], and surface goniometry [4,7,8,15,16,19‐37].…”

Section: Introductionmentioning

confidence: 99%