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Chen KJ, Lee EJ, Kliethermes SA, Scerpella TA. Association of Tibial Tubercle-Trochlear Groove Distance With Risk of ACL Graft Failure. Orthop J Sports Med 2023; 11:23259671231180860. [PMID: 37441506 PMCID: PMC10333637 DOI: 10.1177/23259671231180860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Limited evidence suggests a positive correlation between tibial tubercle-trochlear groove (TT-TG) distance and the risk of native anterior cruciate ligament (ACL) tear. The relationship between TT-TG distance and the risk of ACL graft failure is unknown. Hypothesis TT-TG distance is independently associated with risk of ACL graft failure. Study Design Cohort study; Level of evidence, 3. Methods All patients who underwent ACL revision surgery between 2010 and 2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006 and 2015, with no evidence of graft failure at 8.1 ± 2.5 years postoperatively. Record review included anthropometrics, graft type, and estimated Tegner activity score at ≥6 months after primary ACLR. Magnetic resonance imaging (MRI) scans after native ACL tear (controls) or graft failure (revision cohort) were assessed for (1) TT-TG distance, (2) proximal tibial slopes, (3) depth of tibial plateau concavity, and (4) tunnel position (revision cohort). Associations between ACL graft failure and MRI measurements, surgical variables, and patient characteristics were evaluated with logistic regression analyses. Sensitivity analyses, excluding patients with tunnel malposition, were performed to confirm multivariable results in patients with "ideal" tunnel placement. Results Participants included 153 patients who underwent revisions and 144 controls. Controls were older than the patients who underwent revision (26.6 ± 8.8 vs 20.6 ± 7.3 years; P < .001). The mean TT-TG distance and lateral posterior tibial slope (PTS) were smaller for the control group than for the revision group (TT-TG: 9.3 ± 3.9 vs 11.2 ± 4.2 mm; P < .001; lateral PTS: 6.2° ± 3.3° vs 7.2° ± 3.6°; P = .01). TT-TG distance, lateral PTS, and age were associated with risk of ACL graft failure by multivariable analysis (OR, 1.15; 95% CI, 1.07-1.23; P < .001; OR, 1.13; 95% CI, 1.04-1.22; P = .004; and OR, 0.90; 95% CI, 0.87-0.94; P < .001, respectively). With sensitivity analyses, TT-TG distance, lateral PTS, and age at index surgery remained significantly and independently associated with ACL graft failure. Conclusion Increased TT-TG distance, increased lateral PTS, and younger age are independently associated with increased odds of ACL graft failure. Patients with these characteristics may require a more comprehensive strategy to reduce the risk of ACL reinjury.
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Affiliation(s)
- Kallie J. Chen
- University Hospitals Cleveland Medical
Center/Case Western Reserve University School of Medicine, Cleveland, Ohio,
USA
| | - Eric J. Lee
- Department of Orthopedics and
Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and
Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- School of Medicine and Public Health,
University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Tamara A. Scerpella
- Department of Orthopedics and
Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- School of Medicine and Public Health,
University of Wisconsin–Madison, Madison, Wisconsin, USA
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2
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You S, Shen Y, Liu Q, Cicchella A. Patellofemoral Pain, Q-Angle, and Performance in Female Chinese Collegiate Soccer Players. Medicina (B Aires) 2023; 59:medicina59030589. [PMID: 36984590 PMCID: PMC10054743 DOI: 10.3390/medicina59030589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition has been shown to be higher in females than males. The reporting of knee pain is common in female soccer players, but whether knee pain is associated with morphological features is unclear. The Q-angle of the knee has been hypothesized to be a causal factor in knee pain. Asian females have shown higher levels of valgus than non-sporting Caucasian populations, but no data exist for female Chinese players. The aim of our study was to investigate whether there are associations between knee pain, the Q-angle of the lower limb, jump performance, play time, and perceived exertion in female Chinese collegiate soccer players. Materials and Methods: We measured the Q-angle, patellofemoral/anterior knee pain (SNAPPS questionnaire), and CMJ and SJ performance of 21 subjects (age: 20.09 ± 1.13 years, weight: 56.9 ± 6.26 kg, height: 164.24 ± 4.48 cm, and >10 years of practice) before and after a match; Borg scale and play time results were also recorded. Results: We found that our studied group had higher Q-angles in comparison to other ethnic groups reported in the literature, as well as an association of the Q-angle with the age, height, and weight of the players; however, contrary to other studies, we did not find any association between the Q-angle and knee pain, jumps, play time, or perceived exertion. Knee pain was not associated with any of the measured variables. Conclusions: Female Chinese soccer players showed higher Q-angles than players of other ethnic groups, a result that was associated with anthropometrics. The Q-angle was not found to be associated with knee pain, for which the sole determinant was body height.
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Affiliation(s)
- Songhui You
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Yinhao Shen
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Qingguang Liu
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Antonio Cicchella
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
- Department for Quality-of-Life Studies, University of Bologna, 47921 Rimini, Italy
- Correspondence:
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D’Onofrio R, Alashram AR, Annino G, Masucci M, Romagnoli C, Padua E, Manzi V. Prevention of Secondary Injury after Anterior Cruciate Ligament Reconstruction: Relationship between Pelvic-Drop and Dynamic Knee Valgus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3063. [PMID: 36833752 PMCID: PMC9958946 DOI: 10.3390/ijerph20043063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Optimal neuromuscular, Lumbo-Pelvic-Hip Complex, and lower extremity control are associated with decreased risk factors for secondary anterior cruciate ligament (ACL) injury. This study aimed to analyze any asymmetries and malalignments in the Lumbo-Pelvic-Hip Complex and the lower limbs at 6 months after ACL reconstruction (ACLR). (2) Methods: We conducted an exploratory retrospective observational single-center study in patients during the outpatient postoperative rehabilitation program at ICOT (Latina, Italy). From January 2014 to June 2020, 181 patients were recruited, but only 100 patients (86 male 28 ± 0.6 years, 178 ± 0.5 height; 14 female 24 ± 2.0 years, 178 ± 3.0 height) were eligible for the inclusion criteria and studied 6 months after ACL reconstruction surgery. (3) Statistical analysis: Student's t-tests and Pearson's product-moment correlation coefficient were used to determine significant differences between affected and non-affected limbs and variables' association. (4) Results: The study shows a decrease in neuromuscular control of the Lumbo-Pelvic-Hip Complex and dynamic adaptive valgus of the knee at 6 months after ACLR (mean difference between pathological and healthy limb of dynamic adaptive valgus was -10.11 ± 8.19° 95% CI -14.84 to -9.34; mean value was 16.3 ± 6.8° 95% CI 14.04 to 18.55 for healthy limb and 4.2 ± 3.1° 95% CI 3.15 to 5.21 for pathological limb, p < 0.0001). The results also showed a relationship between dynamic adaptive valgus and contralateral pelvic drop (r = 0.78, 95% CI 0.62 to 0.88, magnitude of correlation very large). (5) Conclusions: The analysis showed an associative correlation between decreased postural control of the pelvic girdle and dynamic adaptive valgus of the knee in 38% of patients; this study highlights the usefulness of the Single-Leg Squat Test (SLST) as a clinical/functional assessment to evaluate the rehabilitation process and as a preventive tool to reduce the risk of second ACL injuries during the return to sport.
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Affiliation(s)
- Rosario D’Onofrio
- Member of the Medical-Scientific Multidisciplinary Commission, Italian Football Doctors Association-L.A.M.I.CA., 04023 Formia, Italy
| | - Anas Radi Alashram
- Department of Physiotherapy, Faculty of Allied Medical Science, Middle East University, Amman 11622, Jordan
| | - Giuseppe Annino
- Centre of Space Bio-Medicine, Department of Medicine Systems, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Matteo Masucci
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Cristian Romagnoli
- Sport Engineering Lab, Department Industrial Engineering, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy
| | - Vincenzo Manzi
- Department of Humanities Science, Pegaso Open University, 80143 Naples, Italy
- Hellas Verona Football Club, Via Olanda 11, 37135 Verona, Italy
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4
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Uludag M, Vergili O, Kilic RT, Oktas B, Yosmaoglu HB. Effect of Q-angle, lateral distal tibial angle and hip muscle torques on ankle injury. Work 2023; 74:159-166. [PMID: 35068431 DOI: 10.3233/wor-210268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The ankle sprain is the most common ankle injury. Although the factors that increase the risk of ankle injury are included in the literature, the definitive evidence is controversial. OBJECTIVE The aim of our study was to examine whether Q-angle, lateral distal tibial angle (LDTA), and hip muscle torque are associated with ankle sprain. METHODS Thirty-six individuals who underwent an axial X-ray examination of the lower extremity following ankle sprain were included. The Q-angle and LDTA were measured on the axial knee X-rays on both sides. The isometric muscle strength was measured with a digital handheld dynamometer for the quadriceps femoris muscle, the gluteus medius muscle and the gluteus maximus muscle. Muscle torques were calculated by multiplying isometric muscle strength values with the distance to the joint center. RESULTS Discrimination analysis shows that the gluteus maximus (0.90), gluteus medius (0.49), quadriceps femoris muscle torques (0.34), and lateral distal tibial angle (0.43) were the factors that most contributed to ankle sprain. No significant relationship was found between the Q-angle and ankle sprain (p = 0.603). A strong relationship was found between LDTA, quadriceps femoris, gluteus medius and gluteus maximus muscle torques and ankle sprain (p = 0.014, p < 0.001, p = 0.011, p = 0.002, respectively). CONCLUSIONS In conclusion, the torques of the proximal muscle may be more related than the Q-angle to lateral ankle sprain injury. Individuals with high LDTA should also be carefully examined for the risk of ankle sprain.
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Affiliation(s)
- Mesut Uludag
- Eldivan Shmyo Geriatric Care Program, Çankırı Karatekin University, Çankırı, Turkey
| | - Ozge Vergili
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Rabia Tugba Kilic
- Department of Physiotherapy, Faculty of Health Sciences, Ankara Yıldirim Beyazit University, Ankara, Turkey
| | - Birhan Oktas
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hayri Baran Yosmaoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey
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Merchant AC. Regarding "Tibial Tubercle Trochlear Groove/Trochlear Width Is the Optimal Indicator for Diagnosing a Lateralized Tibial Tubercle in Recurrent Patellar Dislocation Requiring Surgical Stabilization". Arthroscopy 2022; 38:2775-2776. [PMID: 36192040 DOI: 10.1016/j.arthro.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Alan C Merchant
- Department of Orthopedic Surgery, Stanford University, Stanford, California, U.S.A.; Orthopedic Surgery, El Camino Hospital, Mountain View, California, U.S.A
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6
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Pompeo KD, da Rocha ES, Morales AB, Klein KD, Vaz MA. Does forward step-down task frontal kinematics differ in women with and without patellofemoral pain? A cross-sectional study. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00869-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Lower-Limb Kinematic Change during Pelvis Anterior and Posterior Tilt in Double-Limb Support in Healthy Subjects with Knee Malalignment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159164. [PMID: 35954519 PMCID: PMC9367981 DOI: 10.3390/ijerph19159164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate lower-limb kinematic changes during pelvic tilting in participants with knee malalignment. To define participants with lower-limb malalignment, the quadriceps angle (Q-angle) was used in this study. The sample population was divided into two groups in accordance with the Q-angle: the experimental group (ABQ) consisted of participants with an abnormal Q-angle greater than the normal range, and the control group (CON) consisted of participants with a normal Q-angle. All participants performed anterior and posterior pelvic tilts in double-limb support. Kinematic change in the lower limb was evaluated using a three-dimensional motion analysis system (Motion Analysis, Santa Rosa, CA, USA). The horizontal plane hip angle in the ABQ was significantly different compared with that in the CON in all positions (p < 0.05), and no significant difference was observed in the other lower-limb kinematic variables (p > 0.05). A significant correlation was identified only between the Q-angle and horizontal plane hip angle in all positions. Based on the results, the Q-angle was strongly related to the thigh, although it may not be related to malalignment with other segments during double-limb support.
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Qi Y, Liu J, Sun M, Wang Z. Correlation Analysis between Tibial Tuberosity-Trochlear Groove Distance and Other Patellar Stability Parameters in Young and Middle-aged Populations. Orthop Surg 2022; 14:1817-1826. [PMID: 35711121 PMCID: PMC9363713 DOI: 10.1111/os.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The exact mechanism of patellofemoral instability has not been clearly clarified. The current study aims to explore the correlation between the tibial tuberosity-trochlear groove (TT-TG) distance and other patellar stability parameters. METHODS A total of 60 individuals aged 18 to 40 years who underwent knee computed tomography (CT) examination between September 2014 and December 2017 were retrospectively recruited. Five reference sites were selected on the femoral trochlear articular surface in every CT image. The TT-TG distance and the trochlear groove angles (TGA) at the five reference sites were measured. The patellar ligament length (PLL), patellar length (PL), medial patellar retinaculum length (MPRL) and lateral patellar retinaculum length (LPRL) were quantitatively analyzed. The TT-TG distances on different knee sides or in different sexes were compared. The relationships between the TT-TG distance and TGA, PLL/PL, MPRL, and LPRL were analyzed by Spearman's method. Comparison analysis among patellar stability parameters was analyzed using ANOVA or two-tailed Student's t test. RESULTS Variance analysis revealed no significant differences in the TT-TG distances among the five positions of the femoral trochlea (F = 0.67, P = 0.62) but significant differences among the five femoral TGAs at the five reference sites (F = 380.37, P < 0.01). Notably, an increasing tendency of the TT-TG distance was observed in the sexes (male, range 16.61-19.68 mm; female, range 14.37-17.38 mm) and knee sides (left knee, range 14.37-18.43 mm; right knee, range 15.80-19.68 mm). The TGA at site 1 of the femoral trochlear cartilage was the largest, with an angle of 151.97° ± 10.4°, and then gradually decreased to the smallest when the cartilage disappeared at site 5, with an angle of 92.05° ± 10.01°. Interestingly, there was a positive relationship between the TT-TG distance at site 1 and TGA in the right knees of males (r = 0.490, P = 0.033) as well as LPRL in the left knees of males (r = -0.420; P = 0.046). There were no correlations between the TT-TG distance and the other patellar stability parameters, including TGA, PLL/PL, MPRL, and LPRL. CONCLUSION Among young and middle-aged populations, patella surgeries should be carefully determined based on the comprehensive consideration of these patellar stability parameters rather than the TT-TG distance alone. Differences in sex and knee side should also be considered.
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Affiliation(s)
- Yang Qi
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Jingyan Liu
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Man Sun
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Zhi Wang
- Department of Radiology, Tianjin Hospital, Tianjin, China
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Skouras AZ, Kanellopoulos AK, Stasi S, Triantafyllou A, Koulouvaris P, Papagiannis G, Papathanasiou G. Clinical Significance of the Static and Dynamic Q-angle. Cureus 2022; 14:e24911. [PMID: 35698708 PMCID: PMC9186474 DOI: 10.7759/cureus.24911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Q-angle represents the resultant force vector of the quadriceps and patellar tendons acting on the patella. An increased Q-angle has been considered a risk factor for many disorders and injuries. This literature review challenges the clinical value of static Q-angle and recommends a more dynamic movement evaluation for making clinical decisions. Although there are many articles about static Q-angle, few have assessed the value of dynamic Q-angle. We searched Scopus and PubMed (until September 2021) to identify and summarize English-language articles evaluating static and dynamic Q-angle, including articles for dynamic knee valgus (DKV) and frontal plane projection angle. We also used textbooks and articles from references to related articles. Although static Q-angle measurement is used systematically in clinical practice for critical clinical decisions, its interpretation and clinical translation present fundamental and intractable limitations. To date, it is acceptable that mechanisms that cause patellofemoral pain and athletic injuries have a stronger correlation with dynamic loading conditions. Dynamic Q-angle has the following three dynamic elements: frontal plane (hip adduction, knee abduction), transverse plane (hip internal rotation and tibia external rotation), and patella behavior. Measuring one out of three elements (frontal plane) illustrates only one-third of this concept. Static Q-angle lacks biomechanical meaning and utility for dynamic activities. Although DKV is accompanied by hip and tibia rotation, it remains a frontal plane measurement, which provides no information about the transverse plane and patella movement. However, given the acceptable reliability and the better differentiation capability, DKV assessment is recommended in clinical practice.
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Affiliation(s)
- Apostolos Z Skouras
- Sports Excellence, 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Sophia Stasi
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of West Attica, Athens, GRC
| | - Athanasios Triantafyllou
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
| | - Panagiotis Koulouvaris
- Sports Excellence, 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Georgios Papagiannis
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of the Peloponnese, Sparta, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - George Papathanasiou
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of West Attica, Athens, GRC
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Peng J, Xiao F, Zhu J, Shen C, Li Y, Han X, Cui Y, Chen X. Characteristics of the patellofemoral joint of patients with DDH and the effects of Bernese periacetabular osteotomy on the patellofemoral joint. BMC Musculoskelet Disord 2022; 23:337. [PMID: 35395939 PMCID: PMC8991590 DOI: 10.1186/s12891-022-05291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some patients with developmental dysplasia of the hip (DDH) complained of anterior knee pain (AKP) before and after Bernese periacetabular osteotomy (PAO) surgery. The purpose of this study was to (1) identify the characteristics of patellofemoral joint (PFJ) deformities in patients with DDH and (2) to determine the effects of PAO on the PFJ. METHODS Seventy patients (86 hips) were included in the DDH group. Thirty-three patients (33 knees) without AKP and hip pain were included in the control group. All patients underwent simultaneous CT scans of the hip and knee joints before PAO and after hardware removal surgery. The distance from the anterior inferior iliac spine to the ilioischial line (DAI), was measured in DDH patients. Imaging parameters of knees, including the sulcus angle (SA), femoral trochlear depth (FTD), patellar width (PW), tibial tuberosity-trochlear groove (TT-TG), patellar tilt angle (PTA) and lateral shift of the patella (LSP) were measured in patients in both the DDH and control group. TT-TG, PTA, and LSP of DDH patients were measured before PAO and after hardware removal. The DAI, PTA, LSP and TT-TG of all DDH patients before and after Bernese PAO were compared using paired t-tests. The FTD, PW, and SA of the DDH patients and the control group were analyzed using independent t-tests. PTA, TT-TG, and LSP between the control group and preoperative DDH patients, between the control group and post PAO patients were compared using independent t-tests. RESULTS The DAI changed from 4.04 ± 0.61 mm before PAO surgery to 5.44 ± 0.63 mm after PAO surgery. The SA of the DDH group (140.69 ± 11.30 degree) was greater than that of the control group (130.82 ± 6.43 degree). The FTD and the PW of the DDH group (5.45 ± 1.59 mm, 4.16 ± 0.36 mm) were smaller than that of the control group (7.39 ± 1.20 mm, 4.24 ± 0.38 mm). The changes in LSP, PTA, and TT-TG before and after surgery were not statistically significant. Both before and after PAO, there was no statistically significant difference in the parameters of LSP, PTA, and TT-TG compared with the control group. CONCLUSION The knee joints of DDH patients presented a certain degree of femur trochlear groove dysplasia and patellofemoral instability. PAO surgery did not change PFJ stability, although the origination point of the rectus femoris muscle moved laterally during PAO surgery.
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Affiliation(s)
- Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Fei Xiao
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiuguo Han
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yimin Cui
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China.
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Kasitinon D, Li WX, Wang EXS, Fredericson M. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review. Curr Rev Musculoskelet Med 2021; 14:406-412. [PMID: 34713383 DOI: 10.1007/s12178-021-09730-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Patellofemoral pain syndrome (PFPS) accounts for 25 to 40% of all knee disorders. Diagnosis of PFPS is primarily based on history and physical examination, but the findings on physical examination are often subtle and do not consistently correlate with symptoms described. Yoon and Fredericson published a review article in 2006 detailing the physical examination maneuvers most frequently used to assist clinicians in the accurate diagnosis and treatment of PFPS, and our aim in this review is to provide an update on this previous article focusing on the literature published over the past 15 years regarding the topic. RECENT FINDINGS Since publication of Fredericson's original review article, there have been studies building on the literature specifically surrounding Q angle, patellar tilt, crepitus, strength and functional testing, and physical examination maneuver clustering. Additionally, multiple studies have been conducted on the use of musculoskeletal ultrasound (US) as a diagnostic tool for PFPS. Recent literature has further supported Q angle (when measured utilizing a standardized protocol), crepitus, weakness of hip abductors and extensors, and weakness detected in functional testing as predictors of PFPS while finding inconsistent evidence behind lateral patellar tilt as a predictor of PFPS. The reliability of most physical examination tests alone remain low, but clustering physical examination findings may provide better sensitivities and specificities in diagnosing PFPS. Musculoskeletal US is rapidly gaining popularity, and decreased vastus medialis obliquus (VMO) volume, asymmetry in gluteus medius thickness, intra-articular effusions, and quadriceps and patellar tendon thicknesses have shown value in diagnosing those with PFPS. Additionally, US has the advantage of providing dynamic examination as well as evaluation of the patellofemoral joint in newborns and infants as a predictor of future patellofemoral instability. Further studies are needed to establish the gold standard for diagnosing PFPS and what US findings are truly predictive of PFPS.
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Affiliation(s)
- Donald Kasitinon
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Wei-Xian Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric Xue Song Wang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Hiemstra LA, O'Brien CL, Lafave MR, Kerslake S. Common Physical Examination Tests for Patellofemoral Instability Demonstrate Weak Inter-Rater Reliability. Arthrosc Sports Med Rehabil 2021; 3:e673-e677. [PMID: 34195631 PMCID: PMC8220568 DOI: 10.1016/j.asmr.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/12/2021] [Indexed: 01/26/2023] Open
Abstract
Purpose The purpose of this study was to assess the inter-rater reliability of 3 common physical examination assessments, the Q-angle, J-sign, and apprehension test, used to evaluate patients presenting with recurrent lateral patellofemoral instability. Methods A consecutive sample of 38 subjects with recurrent lateral patellofemoral instability in 2013 were included in this reliability study. Two orthopaedic surgeons performed the physical examination maneuvers blinded to each other. The physical examination tests were performed bilaterally and included the Q angle, the J-sign, and the apprehension test. To measure the inter-rater reliability, an intraclass correlation coefficient (ICC 2,κ) was used for both legs independently for Q-angle measurements. A Cohen’s kappa was used to measure the inter-rater reliability for the J-sign and the apprehension test. Results The measurement of the Q-angle demonstrated poor reliability (ICC 2,κ 0.18-0.44). The assessment of the J-sign demonstrated fair to moderate reliability (κ = 0.31 – 0.41), and the evaluation of apprehension demonstrated fair to substantial reliability (κ = 0.30 – 0.65). All 3 clinical tests demonstrated substantial variability comparing the reliability on the right and left limbs. Assessment of the quality of apprehension demonstrated good agreement between the examiners. Conclusions In this study of patients with recurrent lateral patellofemoral instability the common physical examination tests, Q-angle, J-sign, and apprehension demonstrated weak inter-rater reliability. These results indicate that these tests are not reliable for communication between health care practitioners or as evaluations for clinical research. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Laurie A Hiemstra
- Banff Sport Medicine, Banff, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | | | - Mark R Lafave
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
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Gupta H, Kataria H, Batta NS, Yadav S, Jain V. Assessment of validity and reliability of femoral shaft-patellar tendon angle measured on MRI. Skeletal Radiol 2021; 50:927-936. [PMID: 33026478 DOI: 10.1007/s00256-020-03636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Clinically measured Quadriceps angle (Q-angle) has low reliability. Measurement of angle between femoral shaft and patellar tendon (FSPT angle) on routine knee MRI was described in this study to represent the lateral vector forces of quadriceps mechanism. The cross-sectional study was designed to compare this angle between subjects with objective patellofemoral instability (PFI) versus those without PFI, to assess its reliability, and to assess its validity in terms of its ability to differentiate between PFI and non-PFI subjects using the "Receiver Operating Characteristic" (ROC) curve. MATERIALS AND METHODS MRI scans of 20 subjects with PFI and 20 without PFI were obtained. FSPT angle was measured in each MRI by three different raters. In addition, the clinical Q-angle was also measured in the control group. RESULTS The FSPT angle was significantly higher in PFI group as compared with the non-PFI group (p < 0.001). It had substantial inter-rater reliability of 0.82 (95% CI = 0.67-0.92) in the non-PFI group and 0.89 (95% CI = 0.78-0.95) in the PFI group. Test-retest reliability was more than 0.90. The AUC for the ROC curve was 0.86 (95% CI = 0.74-0.97). The clinical Q-angle measured in non-PFI subjects had inter-rater reliability of only 0.48 (95% CI = 0.21-0.72), and showed a fair correlation of 0.58 with the MRI angle. CONCLUSION Measurement of FSPT angle was described on MRI with substantial intra-rater and inter-rater reliability. The angle was significantly higher in PFI versus non-PFI subjects and also showed a good ability to differentiate between these two groups in the ROC curve.
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Affiliation(s)
- Himanshu Gupta
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India.
| | - Himanshu Kataria
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
| | | | - Sunil Yadav
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
| | - Vineet Jain
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
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Dynamic Q-angle is increased in patients with chronic patellofemoral instability and correlates positively with femoral torsion. Knee Surg Sports Traumatol Arthrosc 2021; 29:1224-1231. [PMID: 32683477 DOI: 10.1007/s00167-020-06163-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/14/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the frontal gait patterns in patients with chronic patellofemoral instability compared to healthy controls. The hypothesis was that internal-rotation-adduction moment of the knee as altered dynamic Q-angle is evident in patients and correlates positively with increased femoral torsion. METHODS Thirty-five patients with symptomatic recurrent patellofemoral instability requiring surgical treatment were matched for average age, sex, and body mass index with 15 healthy controls (30 knees). Several clinical and radiographic measurements were taken from each participant: internal and external rotation (hipIR, hipER), Q-angle, tubercle sulcus angle (TS-angle), femoral antetorsion (femAT), tibial tubercle-trochlear groove (TT-TG) distance, and frontal leg axis. Additionally, three frontal gait patterns were defined and recorded: (1) internal-rotation-adduction moment of the knee during normal walking, (2) dynamic valgus of the knee, and (3) Trendelenburg's sign in a single-leg squat. Randomized videography was evaluated by three independent blinded observers. Statistical analysis was performed using regression models and comparisons of gait patterns and clinical and radiological measurements. Furthermore, observer reliability was correlated to gradings of radiological parameters. RESULTS Patients showed altered dynamic Q-angle gait pattern during normal walking (p < 0.001) compared to healthy controls (interrater kappa = 0.61), whereas highest observer agreement was reported if femAT was greater than 20° (kappa = 0.85). Logistic regression model revealed higher femAT (18.2° ± 12.5 versus 11.9° ± 7.0 (p = 0.004) as a significant variable, as well as lower TT-TG distance (23.6 mm ± 2.8 vs. 16.6 mm ± 4.9, p = 0.004) on evident dynamic Q-angle gait pattern. Dynamic valgus in a single-leg squat was observed significantly more often in patients (p < 0.001) compared to controls (interrater kappa = 0.7). However, besides the static measured Q-angle as the only significant variable on evident dynamic valgus pattern (13.6° ± 4.6 vs. 10.3° ± 5.2, p = 0.003), no radiological parameter was detected to correlate significantly with dynamic valgus and Trendelenburg's sign (n.s.). CONCLUSIONS Clinical detection of pathologic torsion and bony alignment may be difficult in patients with patellofemoral instability. The present study demonstrated that dynamic Q-angle gait pattern is significantly altered in patients with chronic patellofemoral instability compared to healthy controls. Moreover, dynamic Q-angle correlates positively with higher femoral torsion and negatively with higher TT-TG distance. Therefore, clinical and radiological assessment of maltorsion should be added to the standard diagnostic workup in cases of patellofemoral instability. LEVEL OF EVIDENCE Level II.
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Gender differences in femoral trochlea morphology. Knee Surg Sports Traumatol Arthrosc 2021; 29:563-572. [PMID: 32232538 DOI: 10.1007/s00167-020-05944-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. METHODS Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross-section were also analyzed to determine the differences in the depth of the trochlear groove. RESULTS The absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. CONCLUSION Male subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. LEVEL OF EVIDENCE III.
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Flury A, Jud L, Hoch A, Camenzind RS, Fucentese SF. Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree. Knee Surg Sports Traumatol Arthrosc 2021; 29:540-545. [PMID: 32274549 DOI: 10.1007/s00167-020-05970-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The effect of a distal femur varization osteotomy on patellofemoral biomechanics in genu valgum is unknown. The purpose of this study was to quantify the influence of frontal leg axis correction on the Q-angle with a novel three-dimensional (3-D) measurement method. METHODS 3-D surface models of ten lower extremities were generated using patient computed tomography (CT) data. The preoperative 3-D Q-angle was measured using a novel defined and validated 3-D measurement method. Biplanar supracondylar osteotomies were simulated with different degrees of varus correction (from 1° to 15°) in one-degree steps beginning from the preoperative valgus deformity, resulting in a total of 150 simulations. Additionally, mechanical leg axis and 3-D Q-angle measurements were performed on 3-D surface models of the postoperative CT scans of the same individuals. Further, pre- and postoperative TT-TG distance was measured. RESULTS Mean preoperative Q-angle was 15.8 ± 3.9° (range 10°-21.4°) with a mean preoperative mechanical leg axis of 6.5° ± 2.4 valgus (range 3.8°-11.6° valgus). The Q-angle changed linearly 0.9 ± 0° per 1° of varization. No difference was detected between simulated 3-D Q-angles and effectively corrected postoperative values (n.s.). TT-TG distance changed irregularly and minimally, and with no correlation to the degree of varization. CONCLUSION Distal femur varization osteotomy has a linear effect on the Q-angle with a change of 1° per 1° of varization. The difference in TT-TG distance was mainly due to an unintentional rotational component implemented during surgery.
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Affiliation(s)
- A Flury
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - L Jud
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - A Hoch
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - R S Camenzind
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - S F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Evaluation of patients with PFPS using a standardized Q angle measurement protocol. TURKISH JOURNAL OF KINESIOLOGY 2020. [DOI: 10.31459/turkjkin.814557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Load Distribution at the Patellofemoral Joint During Walking. Ann Biomed Eng 2020; 48:2821-2835. [DOI: 10.1007/s10439-020-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
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Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound. Am J Phys Med Rehabil 2020; 99:595-601. [DOI: 10.1097/phm.0000000000001367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Merchant AC, Fraiser R, Dragoo J, Fredericson M. A reliable Q angle measurement using a standardized protocol. Knee 2020; 27:934-939. [PMID: 32295725 DOI: 10.1016/j.knee.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have shown that Q angle measurements were unreliable. Imaging studies have largely replaced the Q angle for measuring tibial tubercle lateralization. Creating a standardized protocol to measure the Q angle, with normative values, would provide a reliable reference without expensive imaging techniques. METHODS Thirty men and 27 women without history of knee problems or family history of dislocating kneecaps were subjects. Exclusion criteria were: patellofemoral abnormalities upon examination. We measured the Q angles of both knees using a standardized protocol and a long-armed goniometer. These data were analyzed to calculate normative values. RESULTS For all subjects, the mean was 14.8° (≈15°), 95% confidence interval (CI): ±5.4°. The male mean was 13.5°, 95% CI: ±5.2°. The female mean was 15.9°, 95% CI: ±4.8°. There was no significant difference between the right and left knees of the males (p = 0.52), nor of the females (p = 0.62), Beta = 0.14. The 2.4° difference between male and female means was due to the average height difference between the men and women. CONCLUSIONS This study provides a standardized Q angle measurement protocol to assess tibial tubercle lateralization at a patient's first encounter (and intra-operatively) without resorting to expensive imaging studies. These values provide a reliable reference for clinical comparison, and will allow all clinicians and sports medicine personnel to assess tubercle lateralization with reliability and validity. When using this protocol, the term "Standard Q Angle" (SQA) should be used, to avoid confusion with other measurement protocols.
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Affiliation(s)
- Alan C Merchant
- Stanford University Sports Medicine, 450 Broadway St., Redwood City, CA 94063, USA.
| | - Ryan Fraiser
- Stanford University Sports Medicine, 450 Broadway St., Redwood City, CA 94063, USA.
| | - Jason Dragoo
- Stanford University Sports Medicine, 450 Broadway St., Redwood City, CA 94063, USA; University of Colorado Health, Steadman Hawkins Clinic, Denver, 175 Inverness Drive West Suite 200, Englewood, CO 80112, USA.
| | - Michael Fredericson
- Stanford University Sports Medicine, 450 Broadway St., Redwood City, CA 94063, USA.
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White AE, Chatterji R, Zaman SU, Hadley CJ, Cohen SB, Freedman KB, Dodson CC. Development of a return to play checklist following patellar instability surgery: a Delphi-based consensus. Knee Surg Sports Traumatol Arthrosc 2020; 28:806-815. [PMID: 31201442 DOI: 10.1007/s00167-019-05510-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/18/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To date, there is no consensus for the appropriate timing or functional evaluation for safe return to play following patellar instability surgery. The purpose of this study is to develop a consensus-based return to play checklist following patellar stabilization surgery using the Delphi method. METHODS A 3-part survey series was conducted following the systematic guidelines of the Delphi technique for gathering consensus from experts in the management of patellofemoral instability. All surveys were completed between July and November of 2017. A literature search was performed in SCOPUS and PubMed to identify existing sources on return to play following patellar instability surgery and determining patellofemoral joint strength in athletes, which served as the basis for the surveys. RESULTS 12 of the 19 selected participants (63%) completed the first-round survey, 11 of those 12 participants (92%) completed the second-round survey, and 10 of these 11 participants (91%) completed the final survey. Of the final ten participants, there was representation from seven different states in the USA. Nine of the ten (90%) respondents endorsed the final checklist. The final checklist included eight overarching domains with defined and reproducible objective criteria. CONCLUSION The standardized list of objective and reproducible criteria for rehabilitation outlined below should help practitioners focus more on patient-centred factors and less on arbitrary timelines. No prior study has gathered consensus from experts on this topic; therefore, this study should serve as a benchmark to help guide patients back to sport safely. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Alex E White
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Rishi Chatterji
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Saif U Zaman
- Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | - Steven B Cohen
- Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Kevin B Freedman
- Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
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Varied influence of the femoral or tibial component on quadriceps angles: Verified by imaging studies. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:287-291. [PMID: 31103418 PMCID: PMC6738274 DOI: 10.1016/j.aott.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/09/2019] [Accepted: 04/28/2019] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study was to evaluate the varied influence of femoral or tibial component on Quadriceps angles (Q-angle) measured with magnetic resonance image (MRI) and full-length standing scanogram (FLSS) techniques. Methods Two groups of patients were studied. The first group underwent MRI studies and the second group underwent FLSS studies. Two-step procedures were carried out. Knee MRI in 60 consecutive adult patients simply taken for meniscus or ligament injuries were utilized at the first step. The standardized patellar center (PC) and tibial tubercle (TT) on the frontal plane of MRI were positioned. At the second step, the FLSS in other 100 consecutive young adult patients taken for chronic unilateral lower extremity injuries were used for locating the two landmarks from MRI. The Q-angle was then determined on the anterior superior iliac spine, standardized PC, and TT on the FLSS. Results For 60 patients, the standardized PC was at the point 42% from the lateral end of the trans-epicondylar line of the femur. The TT was at the point 2 cm distal to the tibial articular surface and 37% from the lateral end of the tibial width. For 100 patients, the Q-angle was an average of 9.5° and 65.2% of the Q-angle was contributed by the upper arm (the femur). Women had a larger Q-angle (10.1° vs. 8.8°, p = 0.02) and a shorter femur (41.1 vs. 44.7 cm, p < 0.001). Conclusion The Q-angle is about 9.5° with 65.2% contributed by the femur. The Q-angle may mainly be influenced by the femoral component. Level of evidence Level IV, Diagnostic Study.
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Saç A, Taşmektepligil MY. Correlation between the Q angle and the isokinetic knee strength and muscle activity. Turk J Phys Med Rehabil 2018; 64:308-313. [PMID: 31453527 PMCID: PMC6648034 DOI: 10.5606/tftrd.2018.2366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/01/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the correlation between the Q angle and the isokinetic knee strength and muscle activity. PATIENTS AND METHODS Between March 2016 and April 2016, a total of 50 healthy and right-leg dominant men (mean age 22.3±2.3 years; range, 18 to 27 years) with a Q angle between 5° and 20° and active in sports were included. An isokinetic strength test of the knee joint extensor and flexor muscles at angular velocities of 60, 120, 180, 240, and 300°·s-1 was tested who had a Q angle of 5 to 20° and were active in sports. Surface electromyography (sEMG) was used to determine these muscles' activity levels. RESULTS Negative correlations were between the Q angle and the average peak torque (APT) in extension (E) and flexion (F), the average power (APE,F) at all angles, the joint angle at the PT (JAPTE) at 240, 180, 120 and 60°·s-1; JAPTF at 300, 240 and 180°·s-1; and the time to PT (TPTF) at 180°·s-1. There was a positive correlation between the Q angle and TPTE (at 60°·s-1). No significant relationship between the Q angle and the level of EMG activity at any angular velocity of the muscles, as well as the VM:VL EMG activity ratio was found. CONCLUSION A higher Q angle is associated with decreased isokinetic knee strength, power output, and torque angles. It is thought that possible high Q angle-related knee joint disorders and sports injuries can be avoided by including proper quadriceps strength exercises in exercise prescriptions to be prepared.
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Affiliation(s)
- Ajlan Saç
- Department of Coaching Education, Kırkpınar School of Physical Education and Sports, Trakya University, Edirne, Turkey
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Barzan M, Maine S, Modenese L, Lloyd DG, Carty CP. Patellofemoral joint alignment is a major risk factor for recurrent patellar dislocation in children and adolescents: a systematic review. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
ImportanceThe complex interplay of risk factors that predispose individuals to recurrent patellar dislocation is poorly understood, especially in paediatric patients who exhibit the most severe forms.ObjectiveThe primary aim of this study was to systematically review the current literature to characterise the lower limb alignment, patellofemoral morphology and soft tissue restraints of the patellofemoral joint (PFJ) through medical imaging measurements in paediatric recurrent patellar dislocators and age-matched control participants. The secondary aims were to synthesise the data to stratify the factors that influence PFJ stability and provide recommendations on the assessment and reporting of PFJ parameters in this patient population.Evidence reviewA systematic search was performed using CINAHL, the Cochrane Library, EMBASE, PubMed and Web of Science databases until June 2017. Two authors independently searched for studies that included typical children and adolescents who experienced patellar dislocation and also had direct measures of structural and dynamic risk factors. The methodological quality of the included studies was assessed through a customised version of the Downs and Black checklist. Weighted averages and SDs of measures that have been reported in more than one study were computed. A fixed-effects model was used to estimate the mean differences with 95% CIs regarding the association of recurrent patellar dislocation with patella alta, tibial tuberosity to trochlear groove (TT-TG) distance and bony sulcus angle.Findings20 of 718 articles met the inclusion criteria. Thirty-one risk factors were found; however, only 10 of these measurements had been assessed in multiple articles and only four had both dislocator and control population results. With respect to controls, patients with recurrent patellar dislocations had higher TT-TG distance (p<0.01) and higher bony sulcus angle (p<0.01).Conclusions and relevanceBased on the current scientific literature, increased TT-TG distances and bony sulcus angles predispose children and adolescents to recurrent patellar dislocation. Besides these measurements, studies reporting on recurrent patellar dislocation in children and adolescents should also include characterisation of lower limb alignment in coronal and axial planes and assessment of generalised ligamentous laxity.Level of evidenceSystematic review of prognostic studies, Levels II–IV.
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Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2018; 26:697-704. [PMID: 28378138 DOI: 10.1007/s00167-017-4527-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements. METHODS Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient. RESULTS The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient. CONCLUSION The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Kristin H Graf
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Marc A Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA.
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Hébert-Losier K, Abd Rahman F. Reliability of postural measures in elite badminton players using Posture Pro 8. Physiother Theory Pract 2017; 34:483-494. [DOI: 10.1080/09593985.2017.1420117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Hébert-Losier
- Faculty of Health, Sport and Human Performance, Adams Centre for High Performance, University of Waikato, Mount Maunganui, Tauranga, New Zealand
- Department of Sports Science, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Fahmi Abd Rahman
- Department of Sports Science, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur, Malaysia
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Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med 2017; 51:1679-1687. [PMID: 28596288 PMCID: PMC5739826 DOI: 10.1136/bjsports-2016-097383] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient's pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. METHODS Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS The literature search identified 9081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short- term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain in the medium and long term, and function and disability in the short, medium and long term, there was no significant difference. CONCLUSION Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO REGISTRATION CRD42016038882.
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Affiliation(s)
- Benjamin E Smith
- Department of Physiotherapy, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | | | - Marcus Bateman
- Department of Physiotherapy, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael S Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Manchester Metropolitan University, Manchester, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT. The Tibial Tubercle-Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions. Am J Sports Med 2017; 45:1110-1116. [PMID: 28056523 PMCID: PMC6010059 DOI: 10.1177/0363546516681002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. PURPOSE To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans. RESULTS The cohort with PFP demonstrated a significantly greater mean TT-TG distance relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = .001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥20 mm. CONCLUSION Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee.
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Affiliation(s)
- Victor R. Carlson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Barry P. Boden
- The Orthopaedic Center, A Division of CAO, Rockville, Maryland
| | - Aricia Shen
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Jennifer N. Jackson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Larry Yao
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
| | - Frances T. Sheehan
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, NIH, Bethesda, Maryland
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Leibbrandt DC, Louw Q. The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:353. [PMID: 30135903 PMCID: PMC6093140 DOI: 10.4102/sajp.v73i1.353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background Anterior knee pain (AKP) or patellofemoral pain syndrome is common and may limit an individual’s ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded. Objectives The aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP. Methods A systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP. Results Two systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment. Conclusion A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.
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Affiliation(s)
- Dominique C Leibbrandt
- Department of Physiotherapy/FNB-3D Movement Analysis Laboratory, Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa
| | - Quinette Louw
- Department of Physiotherapy/FNB-3D Movement Analysis Laboratory, Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa
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Skou N, Egund N. Patellar position in weight-bearing radiographs compared with non-weight-bearing: significance for the detection of osteoarthritis. Acta Radiol 2017; 58:331-337. [PMID: 27287401 DOI: 10.1177/0284185116652013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18-87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.
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Affiliation(s)
- Nikolaj Skou
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Egund
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Mochizuki T, Blaha JD, Tanifuji O, Kai S, Sato T, Yamagiwa H. The Quadriceps Vector is Most Parallel to the Spherical Axis With Minimal Difference for Gender or Ethnicity. J Arthroplasty 2016; 31:2031-7. [PMID: 27067163 DOI: 10.1016/j.arth.2016.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The extensor mechanism may be the key to kinematic alignment of total knee arthroplasty. The purpose of this study was to determine any differences in the direction of the quadriceps vector based on gender or ethnicity and to determine which anatomically derived alignment axis is closest to the quadriceps vector. METHODS Computed tomography scans and patient records for 14 Caucasians (9 men and 5 women) and 40 Japanese (19 men and 21 women) were evaluated. Three axes of alignment-anatomic, mechanical, and spherical-were identified, measured, and compared to the quadriceps vector in each case. Principal component analysis was used to determine the quadriceps vector by using 3-dimensional models of muscles on computed tomography scans. RESULTS No statistically significant differences in the orientation of the quadriceps vector were found based on gender or ethnicity, and the quadriceps vector was most closely aligned with the spherical axis. CONCLUSION Because the quadriceps is the primary knee extensor, the spherical axis therefore may be a ubiquitous guide to alignment of the arthroplasty knee based on motion.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - J David Blaha
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Osamu Tanifuji
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Shin Kai
- Center for Fostering Innovative Leadership, Institute for Research Collaboration and Promotion, Niigata University, Niigata, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Hiroshi Yamagiwa
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, Eng J, Chhabra A. Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc 2016; 24:3021-3028. [PMID: 25941043 DOI: 10.1007/s00167-015-3614-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/16/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To test the inter-observer and inter-method reliability among the measures suggesting patellofemoral joint disorder on both CT and MRI in the same subject and find possible association with internal derangements of the patellofemoral joint on MRI. METHODS Institutional review board approval was obtained with waiver of the informed consent in this HIPPA-compliant study. CT and MRI were evaluated in 32 knees in 32 respective subjects (10 men/22 women, mean age 38 ± 19 years). Three trained observers assessed tibial tuberosity-trochlear groove (TT-TG) distance, trochlear angle and trochlear depth on both CT and MRI. Intra-class correlation coefficient (ICC) was used to evaluate inter-observer and inter-method reliability. Two radiologists' consensus reading was used to evaluate their association with soft tissue abnormalities of the patellofemoral joint. Chi-square test was used to assess the statistical significance of the qualitative variables. RESULTS There was an excellent inter-observer reliability (ICC for CT >0.89 and for MRI >0.90) and inter-method reliability (ICC >0.86) for all the quantitative measurements. There was a significant association between increased TT-TG distance value on MR imaging and lateral facet patellar cartilage abnormality and joint effusion (p < 0.05). CONCLUSION Quantitative trochlear parameters can be reliably calculated on MRI, and an abnormal TT-TG distance is the most useful measurement among various static MR imaging parameters to correlate with patellar chondrosis and joint effusion. TT-TG distance should be reported in patellofemoral pain syndrome patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Rashmi S Thakkar
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Filippo Del Grande
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Majid Chalian
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Gustav Andreisek
- Department of Radiology, University Hospital, Zurich, Switzerland
| | - John A Carrino
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - John Eng
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Avneesh Chhabra
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
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Froehle AW, Grannis KA, Sherwood RJ, Duren DL. Relationships Between Age at Menarche, Walking Gait Base of Support, and Stance Phase Frontal Plane Knee Biomechanics in Adolescent Girls. PM R 2016; 9:444-454. [PMID: 27485675 DOI: 10.1016/j.pmrj.2016.07.532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Age at menarche impacts patterns of pubertal growth and skeletal development. These effects may carry over into variation in biomechanical profiles involved in sports-related traumatic and overuse knee injuries. The present study investigated whether age at menarche is a potential indicator of knee injury risk through its influence on knee biomechanics during normal walking. OBJECTIVE To test the hypothesis that earlier menarche is related to postpubertal biomechanical risk factors for knee injuries, including a wider, more immature gait base of support, and greater valgus knee angles and moments. DESIGN Cross-sectional observational study. SETTING University research facility. PARTICIPANTS Healthy, postmenarcheal, adolescent girls. METHODS Age at menarche was obtained by recall questionnaire. Pubertal growth and anthropometric data were collected by using standard methods. Biomechanical data were taken from tests of walking gait at self-selected speed. Reflective marker position data were collected with a 3-dimensional quantitative motion analysis system, and 3 force plates recorded kinetic data. MAIN OUTCOME MEASURES Age at menarche; growth and anthropometric measurements; base of support; static knee frontal plane angle; and dynamic knee frontal plane angles and moments during stance. RESULTS Earlier menarche was correlated significantly with abbreviated pubertal growth and postpubertal retention of immature traits, including a wider base of support. Earlier menarche and wider base of support were both correlated with more valgus static knee angles, more valgus knee abduction angles and moments at foot-strike, and a more valgus peak knee abduction angle during stance. Peak knee abduction moment during stance was not correlated with age at menarche or base of support. CONCLUSIONS Earlier menarche and its effects on growth are associated with retention of a relatively immature gait base of support and a tendency for static and dynamic valgus knee alignment. This biomechanical profile may put girls with earlier menarche at greater risk for sports-related knee injuries. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Andrew W Froehle
- Lifespan Health Research Center, Department of Community Health and Department of Orthopaedic Surgery, Sports Medicine and Rehabilitation, Wright State University Boonshoft School of Medicine, 3171 Research Blvd, Kettering, OH 45420(∗).
| | - Kimberly A Grannis
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno Medical Education and Research, Fresno, CA(†)
| | - Richard J Sherwood
- Department of Pathology and Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO(‡)
| | - Dana L Duren
- Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, MO(§)
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Almeida GPL, França FJR, Magalhães MO, Burke TN, Marques AP. Ângulo‐q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dickschas J, Harrer J, Bayer T, Schwitulla J, Strecker W. Correlation of the tibial tuberosity-trochlear groove distance with the Q-angle. Knee Surg Sports Traumatol Arthrosc 2016; 24:915-20. [PMID: 25416671 DOI: 10.1007/s00167-014-3426-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/06/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE The Q-angle has been used for years to quantify lateralization of the patella. The tibial tuberosity-trochlea groove distance (TT-TG distance) was introduced to analyse patellar tracking. Does a significant correlation exist between these two parameters? Do other significant interrelations exist between the Q-angle/TT-TG distance, torsion of the femur and tibia, the frontal axis, overall leg length, gender, former patellar dislocation, BMI? METHODS One hundred knees in 55 patients with patellofemoral symptoms were included in a prospective study. All patients underwent clinical examination, including measurement of the Q-angle. A torsional CT was obtained from all patients. RESULTS The correlation coefficient was 0.33/0.34 (left/right leg), showing that the TT-TG distance tends to rise in direct ratio to a rising Q-angle. Thus, a significant correlation was found (p = 0.017). Femoral and tibial torsion had a positive effect on the TT-TG distance, but showed no significant correlation. Leg length had a significant effect on the TT-TG distance (p = 0.04). The frontal axis had a nonsignificant influence on the Q-angle or TT-TG distance. On average, the Q-angle in women was 2.38° greater than it was in men, but the difference was not significant. CONCLUSION A significant correlation was noted between the Q-angle and the TT-TG distance. Both depend on various parameters and must be assessed for the analysis of patellofemoral maltracking. The Q-angle did not differ significantly between men and women; thus, the conclusion is that no different ranges need not be used. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
| | - Jörg Harrer
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
| | - Thomas Bayer
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Judith Schwitulla
- Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstr. 6, 91054, Erlangen, Germany. .,, Universitätsstr. 22, 91052, Erlangen, Germany.
| | - Wolf Strecker
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
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Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Rev Bras Ortop 2016; 51:181-6. [PMID: 27069887 PMCID: PMC4812005 DOI: 10.1016/j.rboe.2016.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/28/2015] [Indexed: 01/29/2023] Open
Abstract
Objective To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). Methods This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. Results The q-angle did not present any significant correlation with severity of knee pain (r = −0.29; p = 0.19), functional capacity (r = −0.08; p = 0.72), FPPA (r = −0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = −0.21; p = 0.35). Conclusion The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.
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Caia J, Weiss LW, Chiu LZF, Schilling BK, Paquette MR. Consistency of Lower-Body Dimensions Using Surface Landmarks and Simple Measurement Tools. J Strength Cond Res 2016; 30:2600-8. [PMID: 26840442 DOI: 10.1519/jsc.0000000000001353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Caia, J, Weiss, LW, Chiu, LZF, Schilling, BK, and Paquette, MR. Consistency of lower-body dimensions using surface landmarks and simple measurement tools. J Strength Cond Res 30(9): 2600-2608, 2016-Body dimensions may influence various types of physical performance. This study was designed to establish the reliability and precision of bilateral lower-body dimensions using surface anatomic landmarks and either sliding calipers or goniometry. Fifty university students (25 men and 25 women) were measured on 2 separate occasions separated by 48 or 72 hours. A small digital caliper was used to acquire longitudinal dimensions of the feet, whereas a larger broad-blade caliper was used to measure lower-limb, hip, and pelvic dimensions. Quadriceps angle (Q-angle) was determined through surface goniometry. Data for all foot and lower-limb dimensions were both reliable and precise (intraclass correlation coefficient (ICC) ≥0.72, SEM 0.1-0.5 cm). Measures of Q-angle were also reliable and precise (ICC ≥0.85, SEM 0.2-0.4°). Findings from this investigation demonstrate that lower-body dimensions may be reliably and precisely measured through simple practical tests, when surface anatomic landmarks and standardized procedures are used. Although intertester reliability remains to be established, meticulous adherence to specific measurement protocols is likely to yield viable output for lower-body dimensions when more sophisticated methods are unavailable or inappropriate.
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Affiliation(s)
- Johnpaul Caia
- 1School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia; 2Musculoskeletal Analysis Laboratory, The University of Memphis, Memphis, Tennessee; and 3Neuromusculoskeletal Mechanics Research Program, University of Alberta, Edmonton, Alberta, Canada
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Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain? Clin Biomech (Bristol, Avon) 2015; 30:1083-7. [PMID: 26381196 DOI: 10.1016/j.clinbiomech.2015.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/11/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. METHOD Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. FINDINGS Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. INTERPRETATION Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.
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Iunes DH, Elias IF, Carvalho LC, Dionísio VC. Postural adjustments in young ballet dancers compared to age matched controls. Phys Ther Sport 2015; 17:51-7. [PMID: 26586041 DOI: 10.1016/j.ptsp.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/27/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of the study was to use photogrammetry to evaluate the posture of ballet practitioners compared to an age-matched control group. DESIGN One hundred and eleven 7- to 24-year-old female volunteers were evaluated and were divided into two groups: the ballet practising group (n = 52) and the control group (n = 59), divided into three subgroups according to age and years of ballet experience. RESULTS Dancers with 1-3 years experience compared to controls of the same age shows alterations in External Rotation Angle (P < 0.05). Dancers 4-9 years experience show alterations in Lumbar Lordosis, Pelvis Tilt Angle and Navicular Angle Right and Left (P < 0.05). Dancers with over 9 years experience show alterations in External Rotation and Navicular Angle Left (P < 0.05). CONCLUSIONS Research shows there are differences between dancers and controls. In the groups 1-3 years and over 9 years of experience, the External Rotation Angle is greater. In the group 4-9 years of experience the Lumbar Lordosis Angle is greater and Pelvis Tilt, Navicular Angle Left and Right are smaller. In more than 9 years of ballet experience, the Navicular Angle Left is smaller.
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Affiliation(s)
- Denise H Iunes
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil.
| | - Iara F Elias
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Leonardo C Carvalho
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Valdeci C Dionísio
- Physiotherapy Course, Federal University of Uberlândia, R. Benjamin Constant, 1286 - Bairro Aparecida, Uberlândia, Minas Gerais, 38400-678, Brazil
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Seitlinger G, Dirisamer F. Tuberositas-tibiae-Osteotomie. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kittl C, Schmeling A, Amis A. Das Patellofemoralgelenk. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koussihouèdé FEN, Falola JM, Fousseni EMB. [A randomized controlled trial: effect of wearing high-heeled shoes on the lower appendicular skeleton]. Pan Afr Med J 2015; 20:191. [PMID: 26113922 PMCID: PMC4469508 DOI: 10.11604/pamj.2015.20.191.4495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 02/24/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Véritable attribut de la féminité, le port de chaussures à talons est devenu une exigence professionnelle dans certaines structures des pays en développement comme le Bénin. L'objectif de ce travail est de déterminer les effets spécifiques du port de chaussures à talons hauts sur le squelette appendiculaire inférieur. Méthodes Des examens radiographiques de face et de profil de la cheville et du genou ont été effectués sur 122 femmes volontaires, âgées en moyenne de 25,09 ± 1,34 ans et ayant les genu varum qui ont participé à cette étude. Résultats Les résultats ont indiqué une augmentation significative de l’écart inter malléolaire, de l’écart inter condylien, de l'angle antérieur du pied et de l'angle fémoro-patellaire. Une diminution significative de l'angle postérieur du pied a été constatée. Conclusion Le port de chaussures à talons hauts est l'une des causes de la gonarthrose, des troubles des articulations de la cheville et du pied.
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Affiliation(s)
- Fifamè Eudia Nadège Koussihouèdé
- Laboratoire de Biomécanique et Performance (Labiop), Institut National de la Jeunesse, de l'Education Physique et du Sport (INJEPS), Porto-Novo, Benin
| | - Jean-Marie Falola
- Laboratoire de Biomécanique et Performance (Labiop), Institut National de la Jeunesse, de l'Education Physique et du Sport (INJEPS), Porto-Novo, Benin ; Laboratory of Human Motricity, Education Sport and Health (LAMHESS), Unité de Formation et de Recherche en Activité Physique et Sportive, Université du Sud, France
| | - El-Mansour Barres Fousseni
- Laboratoire de Biomécanique et Performance (Labiop), Institut National de la Jeunesse, de l'Education Physique et du Sport (INJEPS), Porto-Novo, Benin
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Sanchez HM, Sanchez EGDM, Baraúna MA, Canto RSDT. Evaluation of Q angle in differents static postures. ACTA ORTOPEDICA BRASILEIRA 2014; 22:325-9. [PMID: 25538480 PMCID: PMC4273959 DOI: 10.1590/1413-78522014220600451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/25/2011] [Indexed: 01/31/2023]
Abstract
OBJECTIVE: To compare the value of Q angle in different positions, in the external and internal rotations of lower limbs. METHODS: This is a descriptive cross-sectional study. We have evaluated 62 volunteers, 32 women and 30 men in the following positions: supine positions with parallel feet, supine with abduction (external rotation of lower limbs), and standing position with parallel feet and with external rotation. All the participants were sedentary and without previous history of acute injury or complaints regarding lower limbs. In order to calculate the Q angle we used computerized biophotogrammetry through ALC image 2.1(r) program. RESULTS: The results of the comparisons showed significant difference between the standing position with feet parallel and orthostatic positions with abductees feet on the left side for both genders (p = 0.000). We also found a significant difference between supine and standing position with abducted feet and with feet parallel on the left side (p = 0.046) in females. CONCLUSION: From these results, we can conclude that there are significant differences in the standing position with abducted feet and parallel to the left leg, and symmetry between the lower limbs independent of rotation of limbs in the supine posture. Level of Evidence II, Diagnostic Studies Investigating a Diagnostic Test.
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Amorim MR, Fonseca SFD, Arrieiro AN, Gomes WF, Lacerda ACR. Evaluation of clinical and radiographic measures and reliability of the quadriceps angle measurement in elderly women with knee osteoarthritis. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population.
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Caplan N, Lees D, Newby M, Ewen A, Jackson R, St Clair Gibson A, Kader D. Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability? Knee Surg Sports Traumatol Arthrosc 2014; 22:2377-81. [PMID: 24651980 DOI: 10.1007/s00167-014-2954-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/12/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE II.
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Affiliation(s)
- N Caplan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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Frank RM, Cole BJ. Complex cartilage cases in the athletic patient: advances in malalignment, instability, articular defects, and meniscal insufficiency. PHYSICIAN SPORTSMED 2013; 41:41-52. [PMID: 24231596 DOI: 10.3810/psm.2013.11.2035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
For sports medicine specialists, patients presenting with multiple coexisting knee pathologies can be some of the most difficult to treat patients, especially those with cartilage pathology. In particular, articular cartilage lesions are often incidental findings, and the decision to treat patients must be based on the lesions' confirmed contribution to patient symptomatology. The combination of malalignment, ligamentous instability, and chondral/meniscal damage in patients is challenging to treat because of the difficulty in determining both the relative contribution of each of the pathologies to patient clinical condition and the timing of performing specific corrective procedures. Corrective operations performed in isolation to treat each of the pathologies have historically produced reasonable results in patients; however, combined procedures for treatment of combined pathologies may prove essential for the success of any single procedure. This review describes the clinical evaluation of patients with multiple coexisting knee pathologies and highlights current evidence-based treatment strategies for the management of these combined disorders.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
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The ‘quadriceps angle’: correlation between clinical and radiographic measurements from a study in North Bengal. J ANAT SOC INDIA 2013. [DOI: 10.1016/s0003-2778(13)80016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Herrington L. Does the change in Q angle magnitude in unilateral stance differ when comparing asymptomatic individuals to those with patellofemoral pain? Phys Ther Sport 2013; 14:94-7. [PMID: 23664039 DOI: 10.1016/j.ptsp.2012.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/29/2011] [Accepted: 02/21/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if Q angle changes in magnitude from bilateral stance when compared to unilateral stance and then if they are significantly different changes related to the presence of patellofemoral joint pain. DESIGN Observational correlation. SETTING University biomechanics laboratory. PARTICIPANTS 60 Asymptomatic females and 12 females with patellofemoral joint pain. MAIN OUTCOME MEASURE Bilateral and unilateral stance Q angle. RESULTS Sixty females had their Q angles measured in bilateral and unilateral stance. Linear regressions showed predictive equations and positive correlations for unilateral and bilateral stance Q angles (r=0.81-0.89, p<0.001). The equations generated were used to predict unilateral Q angle from bilateral Q angle measurements in 12 patients with patellofemoral joint pain. The actual unilateral Q angle measurement of the symptomatic knee was significantly greater than that predicted for each individual (p=0.01), whilst the asymptomatic knee showed no significant difference (p=0.16). CONCLUSION This study showed a strong positive relationship between bilateral and unilateral stance Q angles which could be represented in a positive linear regression equation. The linear regression equation was then used to predict the effect on the Q angle of moving from a bilateral to a unilateral stance. It has been found previously that patients with patellofemoral joint pain on loading the limb in unilateral stance in activities such as walking and stair descent have increased knee valgus angle. The current study supports those findings indicating that when taking up unilateral stance patients with patellofemoral joint pain demonstrate greater than expected increase in Q angle which could increase loading on the patellofemoral joint.
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Affiliation(s)
- Lee Herrington
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, UK.
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Greater Q-Angle Measures Are Not Associated With Pain and Muscular or Functional Performance in Elderly Women With Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e31827ea7e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weiss L, DeForest B, Hammond K, Schilling B, Ferreira L. Reliability of Goniometry-Based Q-Angle. PM R 2013; 5:763-8. [DOI: 10.1016/j.pmrj.2013.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/06/2013] [Accepted: 03/16/2013] [Indexed: 01/12/2023]
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