The Angle Of Q Represents
PLoS One. 2019; fourteen(half-dozen): e0218387.
Measurement of the quadriceps (Q) angle with respect to various body parameters in immature Arab population
Ramada R. Khasawneh
1 Section of Basic Medical Sciences, Kinesthesia of Medicine, Yarmouk university, Irbid, Jordan
Mohammed Z. Allouh
2 Department of Anatomy, Faculty of Medicine, Hashemite kingdom of jordan University of Scientific discipline and Engineering science, Irbid, Hashemite kingdom of jordan
Ejlal Abu-El-Rub
3 Department of Physiology and Pathophysiology, Academy of Manitoba, Winnipeg, Canada
Yan Li, Editor
Received 2019 Jan 14; Accepted 2019 May 23.
- Supplementary Materials
-
S1 Fig: A educatee's approved form for conducting the Q angle research. (PDF)
GUID: CD42E7D9-52B1-4C26-921A-79A920545DD9
S2 Fig: The ethical approval of the Institutional Research Board (IRB) at Jordan University of Science and Technology to conduct the Q angle research. (DOCX)
GUID: CAD2E4C5-C6AA-4467-AC4F-1718CEA6BB7D
- Data Availability Statement
-
All relevant information are within the manuscript and its Supporting Information files.
Abstract
The quadriceps angle (Q bending), formed between the quadriceps muscles and the patella tendon, is considered clinically as a very important parameter which displays the biomechanical effect of the quadriceps musculus on the genu, and it is likewise regarded a crucial cistron for the proper posture and movement of the genu patella. The Q angle is routinely and regularly used as an assessment parameter during the diagnosis of many genu-related problems, including the anterior knee pain, osteoarthritis, and degenerative knee disorders. This study had been conducted so as to measure the normal Q angle values range in the Arab nationalities and determine the correlation betwixt Q angle values and several trunk parameters, including gender, acme, weight, dominant side, and the condylar distance of the femur. The study includes 500 healthy young Arab students from the Yarmouk University and Jordan University of Scientific discipline and Engineering. The Q angle of those volunteers was measured using a universal manual Goniometer with the subjects in the upright weight-bearing position. It was institute that Q bending was greater in young women than young men. Also, the analysis of the information revealed an insignificant increase in the ascendant side of the Q angle. In addition, the Q angle was significantly college in the taller people of both sexes. Nevertheless, the Q angle did not nowadays any considerable correlation with weight in the study population; conversely, information technology was clearly observed that there was a link with the condylar distance of the femur in both sexes. It was also noticed that the Q angle increased remarkably when at that place was an increment in the condylar distance. Consequently, it turned out that the gender, height, and the condylar altitude were momentous factors that had impact on the Q angle in our study samples. However, weight and dominancy factors did non prove to accept any influence on the values in our study.
Introduction
The Q angle, which is also known as quadriceps bending, is divers as the angle formed between the quadriceps muscles and the patella tendon. It was described for the showtime time past Brattstrom in 1964 [1]. It is an axiomatic medical fact that the measurement of the Q angle is a very decisive indicator of the biomechanical function in the lower extremity since this measurement reflects the effect of the quadriceps mechanism on the knee joint, it also gives an idea how the thigh muscles function to make the genu moves, as well equally how the knee joint patella tracks in the groove of the genu [two,3]. Moreover, Q bending has go accepted as an of import factor in assessing knee joint part and determining knee wellness in individuals suffering from an inductive genu pain [2–4]. When it is assessed correctly, it will supply very useful information apropos the alignment of the pelvis, leg, and foot [5–7]. It is beyond doubtfulness that misalignment will cause problems to the knee office. Therefore, the conclusion of the Q angle is particularly momentous for patients who are athletically and physically agile [8]. Furthermore, it is essential to mensurate the bending of female patients who walk for health purposes, climb stairs frequently, or participate in a regular form of sports [5,ix].
The literature of the documented values of Q bending past various researchers vary. It is well-known that the normal Q angle should fall betwixt 12 and 20 degrees; the males are usually at the low end of this range; while females tend to have higher measurements [half-dozen,10–xiii]. Other researchers' suggestions that the values should be as depression every bit 10 degrees reflect problems. Recently, some studies accept illustrated that values between viii° and 10° for men and up to 15° for women are deemed normal, just values which are higher than those tin can indicate an abnormality. Davies and Larson have not stated a range for normal values, but they regarded Q angles >20° as excessive [14]. The measurement of Q angle is usually deemed excessive when information technology increases the lateral pull of the quadriceps femoris muscle on the patella and potentiates patellofemora disorders [2,15].
An excessive Q angle indicates a tendency for added biomechanical stress during repetitive activities using the knee [2] because it interferes with the smooth motion of the patella in the femoral groove [two,3]. Over the passage of fourth dimension, especially with sports activities, it will cause muscle imbalance [16] and eventually wearing away of the cartilage on the underside of the patella which tin be translated into the loosing of the articular surface of the articulatio genus [17]. Therefore, the resultant harm is permanent which makes the complete recovery after treatment impossible.
Moreover, excessive Q angle leads to excessive pronation of the pes, and the increase of the pronation time will cause excessive internal rotation of the tibia which volition alter the quadriceps mechanism and lateral tracking of the patella [18]. Somewhen, the more rapid progression from knee dysfunction to patellofemoral arthralgia can be adult into degenerative joint disease. Controlling the foot pronation can oftentimes reduce the detrimental furnishings of an abnormal Q angle [nineteen].
In a nutshell, this study was undertaken to investigate the influence of gender, weight and height and leg dominance on Q-angle utilizing a goniometer with the subject field standing on a weight bearing position. In addition to identifying whatsoever interrelation between the Q angle and the femur condylar, the study is designed to further investigate the mean Q bending in the Arab countries including, some Gulf Countries population with the goal of making the data be used and compared to the values of other parts of the world equally well as to assist improving the clinical diagnosis and cess of the misalignments of the knee joint.
Materials and methods
Study sample
The subjects for the written report were normal healthy adult students from Yarmouk University and the Jordan University of Science and Technology. The students with a history of trauma, fractures, or dislocation in the lower limbs were excluded from the study. As well, participants with musculoskeletal pathology, that could influence the Q-angle were excluded from the written report. The Q angle measurements had been performed bilaterally for each volunteer. The total study sample consisted of 500 volunteers (100 Jordanians, 100 Palestinians, 100 Syrians, 100 Saudis, 50 Kuwaitis and 50 Omanis (with ages ranging from 19 to 25 years. Amid the study subjects, 267 were females and 233 were males.
Measurement procedure
Measurement procedures were performed afterwards securing the approving of the Institutional Research Lath at Just (IRB-# 34-120-2019) (S1 Fig). An appropriate written consent written report was distributed before embarking on the measurements (S2 Fig). In addition, a brief description of the procedure was demonstrated to brand information technology familiar to the subjects after recording their nationalities, age, gender, weight, height, and dominant side on a specific investigation newspaper sheet. Also, the determination of the leg dominance was based on their individual preference when being asked to kick a ball. The Q angle was measured with a full circle universal manual goniometer which is fabricated of articulate plastic with the subject standing in the erect weight-bearing position. The anterior superior iliac spine (ASIS), the midpoint of the patella, and the tibial tuberosity were replaced and determined. The hinge of the goniometer was located at the midpoint of the patella, the goniometer artillery were adjusted to become positioned to the line joining the ASIS and the line joining the tibia tuberosity, then the pocket-sized angle on the goniometer was read every bit the Q angle (Fig 1). Both sides were measured for each individual. Each side was measured iii times, and the mean value of the angle was calculated.
Q angle and marker locations: Anterior Superior Iliac Spine (ASIS) and tibial tuberosity.
A manual caliper, scaled from 0 cm to twenty cm and with a marginal error of ± 1 mm, was used to measure the condylar altitude of the femur for both sides of each volunteer. The discipline first stood in the anatomical position with the anxiety facing forward, and the leg was flexed to 90° with the consequence that the femoral condyles became prominent and easily palpable at that position. Subsequently the stock-still arm of the caliper was placed on the lateral condyle, and the movable arm was and then adjusted to the medial condyle; the condylar distance measurement for each side had been adamant and recorded on the participant'south investigation canvass.
After collecting the requested information and measurements, the information were transferred into a calculator to perform the required statistical analysis.
Statistical assay
After applying the Levene test to determine the homogeneity of variance, the data were evaluated by one-way analysis of variance (ANOVA) or independent samples t-test at 0.05 and 0.01 levels of significance. The Scheffe post hoc assay exam was performed when it was needed to examine statistical differences betwixt the groups when necessary. The data were presented equally hateful ± standard error of the mean (SEM).
Results
Variation in Q angle with sex activity
The volunteers were divided according to sex as follows: male (n = 233) and female groups (due north = 267). The Q angle in both sides was significantly (P<0.01) greater in the female subjects than in the male subjects, such a finding indicated that the Q angle was more prominent in the female person subjects than their counterparts in the male subjects. The mean Q bending ± SEM in the female subjects was 17.35 ± 0.225 o, whereas that in the male person subjects was 14.i ± 0.21o (Fig ii).
Variation of the Q bending with sex in adult population.
The data revealed a remarkable difference in the Q angle between males and females with higher values in females. Each cavalcade represents the mean Q bending ± standard error of the hateful (SE). **P<0.01 (t-test).
Variation in Q angle with summit and weight
A sample of 500 adults aged betwixt 18 and 25 years was divided in line with sex every bit follows: males 233 and females 267. Each category was studied separately and independently then equally to determine the variation in Q angle with respect to acme and weight. The male subjects were divided into iv groups according to their heights with each the height interval of each group was 10cm. It turned out that a significant (P<0.05) variation in Q angle with pinnacle was observed in both sides of the male subjects (Fig 3A). The female subjects were divided into three groups in accordance with their top, with each grouping consisted of a ten-cm interval. Information technology was also found that a considerable (P<0.05) variation in Q angle with height was observed in both sides of the female person subjects (Fig 3B).
Variation of Q angle with respect to height in males (A) and females (B). A columnar representation for the relationship between the hateful Q and the height of in males (A) and in females (B). Values are mean Q angle ± standard error (SE). There is a significant increase in Q angle as the condylar altitude increases in both sides. *P<0.05, **P<0.01.
The male person subjects were divided into v groups on the basis of their weights. Each group included a weight interval of ten kg. Information technology was interesting to find that no significant (P>0.05) variation in Q bending with weight was observed in both sides of the male subjects (Tabular array 1).
Tabular array i
Measurements of the Q bending with respect to weight in the adult men.
| Weight (kg) | Right Q angle | Left Q angle | P value (χ2) |
|---|---|---|---|
| sixty–69 North = 32 | 13.6 ± 0.23° | 13 ± 0.51° | 0.62 |
| lxx–79 Northward = 57 | 14.two ± 0.42° | 13.ix ± 0.33° | |
| 80–89 N = 83 | 14.2 ± 0.xvi° | 14 ± 0.29° | |
| 90–99 N = 32 | xiv.5± 0.71° | 14.2 ± 0.11° | |
| 100–109 Due north = 29 | xv ± 0.11° | fourteen.6 ± 0.xx° |
The female subjects were also divided into v groups in understanding with their weights with each grouping had a weight interval of 10 kg. It was astonishing to discover that in that location was as well no important (P>0.05) variation in Q angle with weight was observed in both sides of the female person subjects (Tabular array 2).
Tabular array ii
Measurements of the Q angle with respect to weight in the adult women.
| Weight (kg) | Right Q angle | Left Q angle | P value (χ2) |
|---|---|---|---|
| 40–49 N = 36 | xvi.nine ± 0.66° | 16.6 ± 0.02° | 0.58 |
| l–59 N = 86 | 17.iv ± 0.12° | 16.8 ± 0.56° | |
| 60–69 N = 90 | 17.5 ± 0.25° | 17 ± 0.38° | |
| 70–79 N = 40 | 17.seven± 0.45° | 17.2 ± 1.1° | |
| 80–89 N = xv | 18.v ± 0.fourscore° | 18 ± 0.nineteen° |
Variation in Q bending with the dominant side
The Q bending was measured in a sample of 437 right-side dominant volunteers with the remarkable upshot that was no significant (P>0.05) between the Q angle measurement of the right and left side in both sexes in the right side-ascendant volunteers. Usually speaking, the Q bending value on the correct side is more than frequently greater than the left. The mean Q bending ± SE was xvi.seven ± 0.43° in the right side and sixteen.iv ± 0.12° in the left side (Fig 4A).
Variation of the Q angle with dominant side in developed population.
(A) right side dominant volunteers showed no significant differences. (B) left side dominant volunteer with the results displayed no significant deviation. Each cavalcade represents the hateful Q angle ± standard error of the mean (SE).
The Q angle was measured in a sample of 63 left-side dominant volunteers. There was as well, no significant (P>0.05) between the Q angle measurement of the right and left side in both sexes in the left side ascendant volunteers. The Q bending value on the left side is more often greater than the left. The mean Q bending ± SE was 16.0 ± 0.51° in the right side and 16.iii ± 0.28° in the left side (Fig 4B).
Variation in Q angle with the condylar distance
A sample of 489 adult volunteers, whose age range was between xviii-25 years, were divided into four groups which was based on the length of their right condylar distance. The right Q bending was measured and compared among those 4 groups. We found that the Q angle and the condylar distance was directly proportional, the Q angle (P<0.05) increased significantly every bit the condylar distance increased (Fig 5A).
Variation of Q angle with condylar distance in males (A) and females (B). A columnar representation for the relationship between the mean Q and the condylar distance of the femur in males (A) and in females (B). Values are mean Q angle ± standard error (SE). At that place is a meaning increase in Q angle as the condylar distance increases in both sides. *P<0.05, **P<0.01.
Additionally, the left Q angle was measured and compared amid the same 4 groups. Nosotros, also came to the same conclusion, we establish that the Q angle (P<0.05) insignificantly increased every bit the condylar distance increased (Fig 5B). Our results indicated that the Q angle is directly correlated with the condylar distance of the femur in the study grouping regardless of which side is measured.
Word
The Q angle (The quadriceps femoris angle) is i of the about clinically used parameter in evaluating the quadriceps forces and factors acting on the patellofemoral joint which is considered to exist as an indicator for sports performance as well as in the diagnosis of several patellofemoral painful disorders and diseases. Knee alignment indicators such as Q angle are highly correlated with the quadriceps femoris muscularity. Any amending in alignment that increases the Q angle is thought to increment the lateral forcefulness on the patella. This can exist harmful because the increase in this lateral force may lead to increase the compression of the lateral patella on the lateral lip of the femoral sulcus. In the presence of a swell enough lateral force, the patella may actually sublux or dislocate over the femoral sulcus when the quadriceps muscle is activated on an extended knee. Information technology has too been found that an abnormal Q angle may also influence neuromuscular response and quadriceps reflex response time [20], consequently, information technology may be a gamble factor for anterior cruciate ligament injury [21].
The aim of this report was to pinpoint the human relationship between the Q angle and various body parameters. Numerous studies on Q angle accept been conducted worldwide aimed to correlate the variations in the Q angle values to the variations in race [xi,12,22]. The present study provides new findings well-nigh the Q bending and its relation to several body parameters in Arab countries population.
The outcomes of this study, which revealed that Q angle was greater in women compared to men, were similar to earlier reported results regarding the variations in Q bending with gender that was higher in females too [13,22]. In our written report, we made use of the goniometer to appraise the accented difference in Q angle between immature men and young women which turned out to exist three.25° higher in females than males. Interestingly, the values of the Q angle in both sexes in Arab population were relatively college than what had been reported in other countries and ethnicities [12]. On the other hand, the mean value in this study appears to be close to the values reported by Clifford [23]. The possible explanation of females having high Q angle values can be attributed to the fact that their pelvis anatomy is wider than males' pelvis which is extrapolated by having a long distance between the pelvis and the patella in comparison to the altitude from the patella to the tibial tuberosity, thereby inducing an alternation in the position of the anterior superioriliac spine that has a huge touch on the Q bending values [24]. These explanations are contrary to what was previously reported by Jaiyesimi, A.O. and Jegede, O.O's studies (2009) which suggested that the difference in the Q angle between the males and females maybe ascribed to the fact that men tend to be taller than women, and that the Q angle is usually slightly smaller in the taller persons [10]. The college Q angle values in females increment the articulating surfaces compression which is clinically important in elucidating the fact regarding why females are at college run a risk of patellofemoral pain. Recent studies have found that high Q-angle values in females are likewise linked to the increase in cartilage thickness measurements of the medial femoral condyle and cartilage grading in female patients of osteoarthritis. The Q angle values in Arab females, measured in the electric current study, are greater than the normal values range reported in other countries and ethnicities, therefore, the Arab females tend to be at greater hazard of developing knee joint abnormalities. The outcomes of our study farther confirmed what was previously discovered regarding the fact that Q angle is significantly smaller in taller person on both sexes. Moreover, previous studies had shown that the quadriceps contraction had a considerable corollary on the Q angle values by affecting the patella position [25,26]. Generally speaking, the fact that males are more physically active than females pb to lower Q angle values as a outcome of their stronger quadriceps muscle.
Based on the findings of the present study, the Q bending values practice non vary significantly with the weight of the written report population. Sra A. et al (2008) also reported no noticeable variation in the Q angle with weight [27].
Relatively speaking, few worldwide studies take focused on Q angle bilateral variability. In the present written report, the Q angle was greater on the dominant side compared with the non-dominant side, but this divergence was non statistically significant. Hahn and Foldspang were amid the first researchers to brand a detailed study of the bilateral variability in the Q angle [8]. Post-obit this study, other studies have documented similar bilateral variations [12,13,27,28] with but ii studies found that this bilateral differences significantly affected the Q angle [27,28].
To further investigate the Q angle, the condylar distance was measured in both legs using a digital caliper. This has been the first study that investigates the relationship between the Q angle and the condylar altitude of the femur. The results show a significant increase in the Q bending equally the condylar distance increases in both sexes. The correlation between Q angle and condylar altitude is clinically important in the diagnosis of degenerative arthritis and other knee joint degenerative abnormalities.
Supporting information
S1 Fig
A student'south approved form for conducting the Q angle research.
(PDF)
S2 Fig
The ethical approval of the Institutional Research Board (IRB) at Jordan University of Science and Technology to conduct the Q angle research.
(DOCX)
Acknowledgments
We would like to give thanks Mr. Muhammad Abu El-Rub for the time and effort spent in reviewing the Manuscript
Funding Statement
This piece of work was supported by Yarmouk University, grant number 25/2017. The funder had no role in written report pattern, data drove and assay, conclusion to publish, or preparation of the manuscript.
Data Availability
All relevant data are within the manuscript and its Supporting Information files.
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