Q Angle in Static and Dynamic Postures

Orthopedic Disorder Clinical Trial

Official title:

Investigation of the Changing of Quadriceps Angle in Static and Dynamic Postures in Healthy Adults and Its Relation With Physical Parameters

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05894551
• Other study ID #: IstanbulUC_dynamicqangle
• Status: Completed
• Start date: May 1, 2022
• Est. completion date: July 15, 2023

Study information

• Verified date: July 2023
• Source: Istanbul University - Cerrahpasa (IUC)
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The Q angle, also known as the quadriceps angle, is defined as the angle formed between the quadriceps muscles and the patella tendon. It was first described by Brattstrom in 1964 (1). The Q angle is the angle between the line extending from the anterior superior of the spina iliaca to the midpoint of the patella and the line extending from the midpoint of the patella to the tuberositas tibia (2). Normally, this angle is between 8-14 degrees in men and 11-20 degrees in women. Any alignment change that increases the Q angle is thought to increase the lateral force on the patella.

The Q angle is generally evaluated in static postures in the literature. The Q angle value varies according to the patient's gender, the contractility of the quadriceps, and the patient's posture (standing or supine) (3).

Q angle was evaluated in a static posture with a standard goniometer or computerized biophotogrammetry (4) Q angle changes with the forces applied by dynamic structures. It is insufficient to evaluate only in a static posture. Therefore, the aim of this study is to examine the effect of dynamic structures on the Q angle using 2D gait analysis (video) and to detect the early signs of deviation of changes in the q angle.

Description:

The Q angle is a very important tool in evaluating the function of the knee joint and describing the biomechanical alignment and function of the lower extremity (5). Abnormal values may cause joint problems later on, and in some cases, may affect the quadriceps reflex time, causing subluxation of the patella or an increased risk of developing anterior cruciate ligament ACL injury (5). For this reason, the Q angle is routinely and regularly used as an evaluation parameter when diagnosing many knee-related problems, including anterior knee pain, osteoarthritis, and degenerative knee disorders. When evaluated correctly, it provides very useful information about the alignment of the pelvis, legs and feet (6-8).

Therefore, determining the Q angle is very important, especially for athletic and physically active patients (9). In most studies, the Q angle was measured using a goniometer or with a modified goniometer (10-12). Biedert et al. by radiography (3). Braz et al. determined the Q angle with digital photogrammetry (13). In the literature, the q angle was generally evaluated in the supine or standing position (14). Higher Q angle values have been reported when transitioning from the supine position to the standing position (15). The increased Q angle while standing has been attributed to changes in lower extremity alignment due to weight bearing. In studies in the literature, the q angle was generally evaluated in static postures. In an ideal postural alignment, there should be a dynamic balance between muscles, joints and skeletal structures (16-17). Not only static structures but also dynamic structures are responsible for problems related to the alignment of the patella. For this reason, it is important to know the changes in the q angle not only in static postures but also in dynamic postures. Evaluation in correct postures is essential for diagnosis, planning and follow-up of the development and results of physical therapy (16).

The primary aim of this study was to report the prevalence and normative reference values of the q angle in the midstance phase of gait using 2D analysis (video).

The secondary aim of this study is to examine the variation of q angles during the midstance phase gait with Q angle values in static postures.

The tertiary aim of this study is to examine the relationship of q angles with different parameters such as age, gender, BMI, lower extremity strength, and hypermobility.

Demographic information (age, weight, height, etc.) will be obtained from healthy volunteers included in the study. As primary outcome measures, q-angles will be measured in static posture (supine and standing) and dynamic posture (with video analysis). Markers will be placed on the relevant places (SIAS, Patella middle and tuberositas tibia). Afterward, the video recordings will be played in slow motion and the evaluators will pause the video during the mid-stance phases of the gait, and the q-angles will be determined with the two-dimensional video analysis software (Kinoveav.0.8.15).

As secondary outcome measures, pelvis width and thigh length with a tape measure and femoral anteversion goniometer with quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength with hand-held dynamometer, joint mobility with Beighton score, foot posture index and functionality will be evaluated by walking 8 meters.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 123
• Est. completion date: July 15, 2023
• Est. primary completion date: June 1, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 25 Years

Eligibility

Inclusion Criteria:

• being between the ages of 18-25

• being volunteer

• not have any condition that may affect cooperation

Exclusion Criteria:

• Individuals with any injury to their lower extremities that cause ligament, muscle or bone defect and any spinal or neurological injury

• individuals diagnosed with any knee disorder such as fracture, acute or chronic knee pain, patella dislocation

Related Conditions & MeSH terms

• Musculoskeletal Diseases
• Orthopedic Disorder
• Quadriceps Muscle

Intervention

Other:
• Evaluation of q angles different positions
Q angle evaluation in two different static postures (upright and supine position) and dynamic posture during the midstance phase of the gait
• Physical examination
With goniometric evaluations, the femoral anteversion angle will be measured. Pelvis width and thigh length will be measured with a tape measure. Quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength will be measured with hand-held dynamometer. Joint mobility will be assessed with the Beighton score and foot posture will be evaluated with the foot posture index-6 (FPI-6).
• Functional mobility assessment
10-meter walking test will be conducted to understand functional mobility.

Locations

Country	Name	City	State
Turkey	Hatay Mustafa Kemal University	Hatay
Turkey	Istanbul University-Cerrahpasa	Istanbul

Sponsors (1)

Lead Sponsor	Collaborator
Istanbul University - Cerrahpasa (IUC)

Country where clinical trial is conducted

Turkey, 

References & Publications (17)

Almeida GP, Silva AP, Franca FJ, Magalhaes MO, Burke TN, Marques AP. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Rev Bras Ortop. 2016 Feb 9;51(2):181-6. doi: 10.1016/j.rboe.2016.01.010. eCollection 2016 Mar-Apr. — View Citation

Biedert RM, Warnke K. Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg. 2001 Jun;121(6):346-9. doi: 10.1007/s004020000239. — View Citation

BRATTSTROEM H. SHAPE OF THE INTERCONDYLAR GROOVE NORMALLY AND IN RECURRENT DISLOCATION OF PATELLA. A CLINICAL AND X-RAY-ANATOMICAL INVESTIGATION. Acta Orthop Scand Suppl. 1964;68:SUPPL 68:1-148. No abstract available. — View Citation

Braz RG, Carvalho GA. Relationship between quadriceps angle (Q) and plantar pressure distribution in football players. Rev Bras Fisioter. 2010 Jul-Aug;14(4):296-302. Epub 2010 Sep 3. English, Portuguese. — View Citation

Choudhary R, Malik M, Aslam A, Khurana D, Chauhan S. Effect of various parameters on Quadriceps angle in adult Indian population. J Clin Orthop Trauma. 2019 Jan-Feb;10(1):149-154. doi: 10.1016/j.jcot.2017.11.011. Epub 2017 Nov 23. — View Citation

Daneshmandi H, Saki F, Shahheidari S, Khoori A. Lower extremity Malalignment and its linear relation with Q angle in female athletes. 3rd World Conf Educ Sci-2011. 2011;15: 3349-3354.

Greene CC, Edwards TB, Wade MR, Carson EW. Reliability of the quadriceps angle measurement. Am J Knee Surg. 2001 Spring;14(2):97-103. — View Citation

Guerra JP, Arnold MJ, Gajdosik RL. Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther. 1994 Apr;19(4):200-4. doi: 10.2519/jospt.1994.19.4.200. — View Citation

Iunes DH, Castro FA, Salgado HS, Moura IC, Oliveira AS, Bevilaqua-Grossi D. Confiabilidade intra e interexaminadores e repetibilidade da avaliação postural pela fotogrametria. Rev Bras Fisioter. 2005;9(3):327-334.

Khasawneh RR, Allouh MZ, Abu-El-Rub E. Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PLoS One. 2019 Jun 13;14(6):e0218387. doi: 10.1371/journal.pone.0218387. eCollection 2019. — View Citation

Merchant AC, Fraiser R, Dragoo J, Fredericson M. A reliable Q angle measurement using a standardized protocol. Knee. 2020 Jun;27(3):934-939. doi: 10.1016/j.knee.2020.03.001. Epub 2020 Apr 12. — View Citation

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med. 2009 May;19(3):201-6. doi: 10.1097/JSM.0b013e3181a38fb1. — View Citation

Omololu BB, Ogunlade OS, Gopaldasani VK. Normal Q-angle in an adult Nigerian population. Clin Orthop Relat Res. 2009 Aug;467(8):2073-6. doi: 10.1007/s11999-008-0637-1. Epub 2008 Nov 26. — View Citation

Raveendranath R, Nachiket S, Sujatha N, Priya R, Rema D. Bilateral Variability of the Quadriceps Angle (Q angle) in an Adult Indian Population. Iran J Basic Med Sci. 2011 Sep;14(5):465-71. — View Citation

Rosario L.R. What is posture? a review of the literature in search of a definition. EC Orthopaedics. 2017;6(3):111-133.

Sacco I.C.N., AlIbert S., Queiroz B.W., Pripas D., KlelIng I., Kimura A.A. Reliability of photogrammetry in relation to goniometry for postural lower limb assessment. Rev Bras Fisioterpp. 2007;11(5):411-417.

Yilmaz A, Kabadayi M, Mayda M, Çavusoglu G, Tasmektepligi M. Analysis of Q Angle Values of Female Athletes from Different Branches. Sci Mov Heal. 2017;17: 141-146.

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Q angle	Q angle measurement in three different position; in supine, standing and midstance phase during gait. The static and dynamic positions of the participants will be recorded as a photo and frame from video recording, then the measurements will be conducted with 2-dimensions movement analysis software. The unit of measurement will be recorded in angle degree.	baseline
Secondary	Pelvic width	Pelvic width will be measured with a tape and the unit of measurement will be recorded in centimeters.	baseline
Secondary	Thigh length	It will be measured with a tape and the unit of measurement will be recorded in centimeters.	baseline
Secondary	Femoral anteversion angle	The femoral anteversion angle will be measured with goniometer. The normal angle is +10 degrees, with a range of -3 to +20 degrees. The unit of measurement will be recorded in angle degree.	baseline
Secondary	Lower extremity muscle strength	Quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength will be measured with hand-held dynamometer. The unit of measurement will be recorded in libre.	baseline
Secondary	Beighton score	Joint mobility will be assessed with the Beighton score. Simple actions like bending your pinky (little) finger backward to evaluate the joint angle are involved. A nine-point scoring system is used for the Beighton score. The joints are more flexible the higher your score.	baseline
Secondary	Foot posture index-6	Foot posture will be evaluated with the foot posture index-6 (FPI-6). The FPI-6 is a rapid, accurate diagnostic tool that rates foot posture using predetermined criteria and an easy scale. It is used to determine how pronated, neutral, or supinated a foot is. Pronated postures are given a positive value, the higher the value the more pronated.; Supinated features are given a negative value, the more negative the value the more supinated.; For a neutral foot the final FPI aggregate score should lie somewhere around zero.	baseline
Secondary	10-meter walking test	10-meter walking test will be conducted to understand functional mobility. The 10 Metre Walk Test is a performance indicator used to evaluate walking speed over a brief distance in meters per second. To assess functional mobility, gait, and vestibular function, it can be used. The cut-off values like that; Household Ambulator <0.40 m/s; Limited Community Ambulator 0.40 to <0.80 m/s; Community Ambulator =0.80 m/s. the unit of measurement will be recorded in second.	baseline