Korrelation zwischen Q-Winkel und Patellaposition

  • R. M. Biedert


Das patellofemorale Schmerzsyndrom stellt ein häufiges und bedeutendes Problem sowohl für den Patienten wie auch für den behandelnden Arzt dar. Dabei wird ein abnormales Alignment der Patella, das sog. Malalignment, als ein wesentlicher extrinsischer Faktor in der Verursachung von patellofemoralen Schmerzen beschrieben. Eine vielfach angewendete Untersuchung zur klinischen Beurteilung des Malalignment ist die Messung des Quadri-zepswinkels (Q-Winkel) [5]. Der Q-Winkel ist definiert als der Winkel zwischen einer ersten Linie die die Spina iliaca anterior superior und das Zentrum der Patella verbindet und einer zweiten Linie zwischen dem Zentrum der Patella und der Tuberositas tibiae [5] (Abb. 1). Der Q-Winkel verursacht biomechanisch eine nach lateral gerichtete Kraft an der Patella, durch welche die Patella nach außen und der laterale Femurkondylus nach dorsal gedrückt wird [18]. Damit kontrolliert und stabilisiert der Q-Winkel die Rotation rund um das Kniegelenk. Gleichzeitig werden durch die Auswirkung des Q-Winkels Femur und Tibia aneinander gepresst.

Eine klinische und computertomografische Evaluation


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aglietti P, Insall JN, Cerulli G (1983) Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop 176:217–224PubMedGoogle Scholar
  2. 2.
    Biedert RM, Gruhl C (1997) Axial computed tomography of the patellofemoral joint with and without quadriceps contraction. Arch Orthop Trauma Surg 116:77–82PubMedCrossRefGoogle Scholar
  3. 3.
    Biedert RM, Warnke K (1998) Correlation between the Q angle and the patella position: a clinical and axial CT evaluation. Proceedings of the International Patellofemoral Study Group, Lyon, FranceGoogle Scholar
  4. 4.
    Brown DE, Alexander AH, Lichtman DM (1984) The Elmslie-Trillat procedure: Evaluation in patellar dislocation and subluxation. Am J Sports Med 12:104–108PubMedCrossRefGoogle Scholar
  5. 5.
    Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17:11–15PubMedGoogle Scholar
  6. 6.
    Dandy DJ (1995) Chronic patellofemoral instability. J Bone Joint Surg [Br] 78:328–335Google Scholar
  7. 7.
    Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H (1984) Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg 66B:685–693Google Scholar
  8. 8.
    Feagin JA (1994) The crucial ligaments: Diagnosis and treatment of ligament injuries about the knee. Churchill Livingstone, New YorkGoogle Scholar
  9. 9.
    Ford DH, Post WR (1997) Open or arthroscopic lateral release. Indications, techniques and rehabilitation. Clin Sports Med 16:29–49PubMedCrossRefGoogle Scholar
  10. 10.
    Guzzanti V, Gigante A, Di Lazzaro A, Fabbriciani C (1994) Patellofemoral malalignment in adolescents. Computerized tomographic assessment with or without quadriceps contraction. Am J Sports Med 22:55–60PubMedCrossRefGoogle Scholar
  11. 11.
    Horton MG, Hall TL (1989) Quadriceps femoris muscle angle: Normal values and relationships with gender and selected skeletal measures. Phys Ther 69:897–901PubMedGoogle Scholar
  12. 12.
    Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. J Bone Joint Surg [Am] 66:715–724Google Scholar
  13. 13.
    Insall J (1979) „Chondromalacia patellae“: Patellar malalignment syndrome. Orthop Clin North Am 10:117–127PubMedGoogle Scholar
  14. 14.
    Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae: A prospective study. J Bone Joint Surg [Am] 58:1–8Google Scholar
  15. 15.
    Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: Indications and contraindications. Am J Sports Med 18:359–365PubMedCrossRefGoogle Scholar
  16. 16.
    Kujala UM, Österman K, Kormano M, Nelimarkka O, Hurme M, Taimela S (1989) Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg [Br] 71:788–792Google Scholar
  17. 17.
    Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ (1991) Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc 23:1008–1015PubMedGoogle Scholar
  18. 18.
    Müller W (1983) The knee. Form, function, and ligament reconstruction. Springer, BerlinGoogle Scholar
  19. 19.
    Papagelopoulos PI, Sim FH (1997) Patellofemoral pain syndrome: diagnosis and management. Orthopaedics 20:148–157Google Scholar
  20. 20.
    Paulos L, Rusche K, Johnson Ch, Noyes FR (1980) Patellar malalignment. A treatment rationale. Phys Ther 60:1624–1632PubMedGoogle Scholar
  21. 21.
    Percy EC, Strother RT (1985) Patellalgia. Phys Sportsmed 13:43–59Google Scholar
  22. 22.
    Post WR (2000) New assessment of value clinical indicators of malalignment. Proceedings of the 67th Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando FL, 249–250Google Scholar
  23. 23.
    Rillmann P, Dutly A, Kieser C, Berbig R (1998) Modified Elmslie-Trillat procedure for instability of the patella. Knee Surg Sports Traumatol Arthrosc 6:31–35PubMedCrossRefGoogle Scholar
  24. 24.
    Sasaki T, Yagi T (1986) Subluxation of the patella. Investigation by computerized tomography. International Orthopaedics (SICOT) 10:115–120CrossRefGoogle Scholar
  25. 25.
    Terry GC (1989) The anatomy of the extensor mechanism. Clin Sports Med 8:163–177PubMedGoogle Scholar
  26. 26.
    Thomee R, Renström P (1995) Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 5:237–244PubMedCrossRefGoogle Scholar
  27. 27.
    Westfall DC, Worell TW (1992) Anterior knee pain syndrome: Role of the vastus medialis oblique. J Sport Rehab 1:317–325Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • R. M. Biedert

There are no affiliations available

Personalised recommendations