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Q-angle and J-sign: Indicative of Maltracking Subgroups in Patellofemoral Pain

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Clinical Orthopaedics and Related Research®

Abstract

Mechanical factors related to patellofemoral pain syndrome and maltracking are poorly understood. Clinically, the Q-angle, J-sign, and lateral hypermobility commonly are used to evaluate patellar maltracking. However, these measures have yet to be correlated to specific three-dimensional patellofemoral displacements and rotations. Thus, we tested the hypotheses that increased Q-angle, lateral hypermobility, and J-sign correlate with three-dimensional patellofemoral displacements and rotations. We also determined whether multiple maltracking patterns can be discriminated, based on patellofemoral displacements and rotations. Three-dimensional patellofemoral motion data were acquired during active extension-flexion using dynamic MRI in 30 knees diagnosed with patellofemoral pain and at least one clinical sign of patellar maltracking (Q-angle, lateral hypermobility, or J-sign) and in 37 asymptomatic knees. Although the Q-angle is assumed to indicate lateral patellar subluxation, our data supported a correlation between the Q-angle and medial, not lateral, patellar displacement. We identified two distinct maltracking groups based on patellofemoral lateral-medial displacement, but the same groups could not be discriminated based on standard clinical measures (eg, Q-angle, lateral hypermobility, and J-sign). A more precise definition of abnormal three-dimensional patellofemoral motion, including identifying subgroups in the patellofemoral pain population, may allow more targeted and effective treatments.

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Acknowledgments

We thank Ching-yi Shieh, PhD, and Elizabeth K. Rasch, PT, PhD, for support on the statistical analysis and Steven Stanhope, PhD, for guidance throughout the project. We also thank Bonnie Damaska, Jamie Fraunhaffer, Jere McLucas, Dr. Barry Boden, and the Diagnostic Radiology Department at the National Institutes of Health for their support and research time.

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Authors and Affiliations

  1. National Institutes of Health, Building 10 CRC, Room 1-1469, 10 Center Drive MSC 1604, Bethesda, MD, 20892-1604, USA

    Frances T. Sheehan PhD

  2. Department of Orthopaedics, University of Miami, Miami, FL, USA

    Aditya Derasari MD

  3. The Orthopaedic Center, Rockville, MD, USA

    Kenneth M. Fine MD

  4. Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA

    Timothy J. Brindle PhD & Katharine E. Alter MD

  5. Walter Reed Army Medical Center, Washington, DC, 20307, USA

    Timothy J. Brindle PhD

  6. Mt Washington Pediatric Hospital, Baltimore, MD, USA

    Katharine E. Alter MD

Authors
  1. Frances T. Sheehan PhD
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  2. Aditya Derasari MD
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  3. Kenneth M. Fine MD
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  4. Timothy J. Brindle PhD
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  5. Katharine E. Alter MD
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Corresponding author

Correspondence to Frances T. Sheehan PhD.

Additional information

This research was supported in part by the Intramural Research Program of the National Institutes of Health (Clinic Center and National Institute of Child Health and Human Development).

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent and assent, if the subject was a minor, was obtained.

Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Institutes of Health or the US Public Health Service.

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Sheehan, F.T., Derasari, A., Fine, K.M. et al. Q-angle and J-sign: Indicative of Maltracking Subgroups in Patellofemoral Pain. Clin Orthop Relat Res 468, 266–275 (2010). https://doi.org/10.1007/s11999-009-0880-0

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