Abstract
Patellar malalignment is the most important reason for anterior knee pain. Patellar alignment is commonly determined by the measurement of the quadriceps (Q) angle. In this study, our primary aim was to investigate the Q angle difference between healthy individuals with and without joint hypermobility. The other objectives were to compare the Q angle values, which were measured in supine and upright positions, to determine hypermobility frequency among healthy males in a certain population, and to investigate the correlation between the existent skeletal deformities and Beighton score levels. Two hundred fifty-three healthy male college students were examined for hypermobility and skeletal deformities. According to the Beighton scoring system, three groups (n=20) were formed, and Q angle measurements were performed on the 60 individuals in both supine and upright positions. In the comparison of the groups, the mean Q angle values in healthy hypermobile individuals were found to be significantly higher than that of the nonhypermobile ones (p<0.05). No statistical difference was found between Q angle values in supine and upright positions (p>0.05). The frequency of joint hypermobility (Beighton score 4 or more) was found to be 29.25% in this population. No correlation was determined between existent skeletal deformities and Beighton score values (p>0.05). In conclusion, the Q angle evaluation among healthy hypermobile individuals may have a prognostic value for probable knee pathologies that may appear in the future.
Similar content being viewed by others
References
France L, Nester C (2001) Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech 16:710–713
Hirokawa S (1991) Three-dimensional mathematical model analysis of the patellofemoral joint. J Biomech 24:659–671
Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of Q angle and tendofemoral contact. J Bone Joint Surg Am 66:715–724
Hughston JC (1984) Subluxation of the patella. J Bone Joint Surg Am 50:1003–1026
Insall J (1979) Chondromalacia patellae: patellar malalignment syndrome. Orthop Clin North Am 10:117–127
Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56:1391–1396
Hungerford DS, Barry M (1979) Biomechanics of the patellofemoral joint. Clin Orthop 144:9–15
Aglietti P, Buzzi R, Insall JN (1993) Disorders of the patellofemoral joint. In: Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti P (eds) Surgery of the knee, 2nd edn. Churchill Livingstone, New York pp 241–385
Fulkerson JP, Shea KP (1990) Disorders of patellofemoral alignment. J Bone Joint Surg Am 72:1424–1429
Larsson LG, Baum J, Govind S, Kollia M, Kollia GD (1993) Benefits and disadvantages of joint hypermobility among musicians. N Engl J Med 329:1079–1082
Perrini F, Tallents RH, Katzberg RW, Riberio RJ, Kyrkanides S, Moss ME (1997) Generalized joint laxity and temporomandibular disorders. J Orofac Pain 11:215–220
Grahame R (1999) Joint hypermobility and genetic collagen disorders: are they related? Arch Dis Child 80:188–191
Beighton P (1993) The Ehlers Danlos syndromes. In: Beighton P (ed) McKusick's heritable disorders of connective tissue, 5th edn. Mosby, St. Louis p 206
Kraus VB, Li YJ, Martin ER, Jordan JM, Renner JB, Doherty M, Wilson AG, Moskowitz R, Hochberg M, Loeser R, Hooper M, Sundseth S (2004) Articular hypermobility is a protective factor for hand osteoarthritis. Arthritis Rheum 50:2178–2183
Beighton P, Gahame R, Bird H (1999) Assessment of hypermobility. In: Beighton P (ed) Hypermobility of joints, 3rd edn. Springer, Berlin Heidelberg New York pp 9–22
Hudson N, Fitzcharles M-A, Cohen M, Star MR, Esdaile JM (1998) The association of soft-tissue rheumatism and hypermobility. Br J Rheumatol 37:382–386
Bulbena A, Duro JC, Porta M, Faus S, Vallescar R, Martin-Santos R (1992) Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol 19:115–122
Barron DF, Cohen BA, Geraghty MT, Violand R, Rowe PC (2002) Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls. J Pediatr 141:421–425
Qvindesland A, Jonsson H (1999) Articular hypermobility in Icelandic 12-year-olds. Rheumatology 38:1014–1016
Harreby M, Nygaard B, Jessen T, Larsen E, Storr-Paulsen A, Lindahl A, Fisker I, Laegaard E (1999) Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study. Eur Spine J 8:444–450
El-Garf AK, Mahmoud GA, Mahgoub EH (1998) Hypermobility among Egyptian children: prevalence and features. J Rheumatol 25:1003–1005
Rikken-Bultman DG, Wellink L, van Dongen PW (1997) Hypermobility in two Dutch school populations. Eur J Obstet Gynecol Reprod Biol 73:189–192
Subramanyam V, Janaki KV (1996) Joint hypermobility in south Indian children. Indian Pediatr 33:771–772
Al-Rawi ZS, Al-Aszawi AJ, Al-Chalabi T (1985) Joint mobility among university students in Iraq. Br J Rheumatol 24:326–331
Birrell FN, Adebajo AO, Hazleman BL, Silman AJ (1994) High prevalence of joint laxity in West Africans. Br J Rheumatol 33:56–59
Aglietti P, Insall JN, Cerulli G (1983) Patellar pain and incongruence: I. Measurements of incongruence. Clin Orthop 176:217–224
Boucher JP, King MA, Lefebvre R, Pepin A (1992) Quadriceps femoris muscle activity in patellofemoral pain syndrome. Am J Sports Med 20:527–532
Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17:11–16
Chen S (1997) The experimental study of Q angle variety during knee flexion. Chin J Sports Med 16:91–94
Hvid I, Andersen LI (1982) The quadriceps angle and its relation to femoral torsion. Acta Orthop Scand 53:577–579
Hvid I, Andersen LI, Schmidt H (1981) Chondromalacia patellae: the relation to abnormal patellofemoral joint mechanics. Acta Orthop Scand 52:661–666
Decoster LC, Vailas JC, Lindsay RH, Williams GR (1997) Prevalence and features of joint hypermobility among adolescent athletes. Arch Pediatr Adolesc Med 151:989–992
Mikkelsson M, Salminen JJ, Kautiainen H (1996) Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents. J Rheumatol 23:1963–1967
Gedalia A, Brewer EJ Jr (1993) Hypermobility in pediatric practice—a review. J Rheumatol 20:371–374
Arroyo IL, Brewer EJ, Giannini EH (1988) Arthritis/arthralgia and hypermobility of the joints in schoolchildren. J Rheumatol 15:978–980
Gedalia A, Person DA, Brewer EJ Jr, Giannini EH (1985) Hypermobility of the joints in juvenile episodic arthritis/arthralgia. J Pediatr 107:873–876
Lewkonia RM, Ansell BM (1983) Articular hypermobility simulating chronic rheumatic disease. Arch Dis Child 58:988–992
Mikkelsson M (1999) One year outcome of preadolescents with fibromyalgia. J Rheumatol 26:674–682
Horton MG, Hall TL (1989) Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther 69:897–901
Livingston LA (1998) The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther 28:105–109
Woodland LH, Francis RS (1992) Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. Am J Sports Med 20:208–211
Insall JN, Aglietti P, Tria AJ (1983) Patellar pain and incongruence: II. Clinical application. Clin Orthop 176:225–232
Noll BJ, Ben-Itzhak I, Rossouw P (1988) Modified technique for tibial tubercle elevation with realignment for patellofemoral pain: a preliminary report. Clin Orthop 234:178–182
Zimbler S, Smith J, Scheller A, Banks HH (1980) Recurrent subluxation and dislocation of the patella in association with athletic injuries. Orthop Clin North Am 11:755–770
Nagamine R, Whiteside LA, White SE, McCarthy DS (1994) Patellar tracking after total knee arthroplasty: the effect of tibial tray malrotation and articular surface configuration. Clin Orthop 304:263–271
Paulos L, Rusche K, Johnson C, Noyes FR (1980) Patellar malalignment: a treatment rationale. Phys Ther 60:1624–1632
Guerra JP, Arnold MJ, Gajdosik RL (1994) Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther 19:200–204
Doucette SA, Goble EM (1992) The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med 20:434–440
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sendur, O.F., Gurer, G., Yildirim, T. et al. Relationship of Q angle and joint hypermobility and Q angle values in different positions. Clin Rheumatol 25, 304–308 (2006). https://doi.org/10.1007/s10067-005-0003-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-005-0003-6