PST325:PATHOKINESIOLOGYPathomechanics oftheKnee

TheQ-AngleInstructors:ProfMOBOlaogun

Mrs JOAdeleke

TheQuadricepsAngle[Q-Angle]

•WhatistheQuadricepsAngle?•Howisitmeasured?•Whyisitimportanttothephysiotherapist?•WhataretheNormalvalues?•Whatarethecausesofabnormalvalues?•Anyimplicationofabnormalvaluesinsporting/recreationalactivities?

TheKneejoint[Revision]

•Kneeisthelargestjointinthebody• Involvedinapproximately50%ofmusculoskeletalinjuries….•3joints-•Tibiofemoral (2)•Patellofemoral

•Musclesandtendonsaroundthekneejoint[Assignment– NamesandNervesupply]•Accessoryquadriceps

TheKneejointcontd

•Ligaments[Assignment- NamesandPositions]•Sessamoid bones•Patella•Fabella

•Theroleofthepatellaasapulley

TheKneejointcontd.

Whataretheclinicalimplicationsof•PatellaAlta[Highriding]?•PatellaBaja[Lowriding]?

RadiographoftheKneejoint

Install-Salvati Ratio-HeightofPatella:Length ofLigamentum Patellae

TheQ-Angle

•Anglebetweenthequadricepsmuscle(primarilyrectusfemoris)andthepatellaligament.

•Ameasureofpatellofemoral mechanics[Biomechanics]

•Acuteangleformedbythevectorforcombinedpullofthequadricepsmuscleandthepatellatendon

•Angleformedbytheresultantforceofthequadricepsfemoris muscleonthebaseofthepatellaandthelineofpullofthepatellaligamentontheapexpfthepatella.•Measurementofpelvicwidththatisthoughttocontributetosportsinjuryrisksinwomen.

HowisQ-Anglemeasured?

•Measuredasanangleformedbythelineconnectingtheanteriorsuperioriliacspine(ASIS)tothecenterofthepatellaandthelineconnectingthecenterofthepatellatothetipoftibial tuberosity(measuredwithagoniometer)•Estimatednormalvalueandgendervariation-14oinMenand17o Women[Seethetablebelow]

Meaurement oftheKneejoint(Supine)

ValuesofQ-Angles*Men Women

Right Left Right Left

Supine 10.7+2.20

10.5+ 21+4.8 20.94+4.6

Standing 12.3+2.2

11.7+2.8

22.8+4.7

22.7+4.6

• *Omololu etal.,2009.[Studyof477Nigerianadults(354menand123women).StudyshowedthattheQ-angleinadultNigerianmeniscomparabletothatofadultcaucusian,butq-angleoftheNigerianwomengreaterthanthatoftheCaucasiancoutnerparts.

_________________________________________________________Omololu,BB…(2009) ;ClinicalOrthopaedicsandRelatedResearch,pp2073-2078.August2019.

ImportanceofQ-Angle

Q-Angleisformedbythevectorforcombinedpullofthequadricepsfemoris musclesandthePatellatendonduringkneeextenion•Alateralpullisexertedonthepatella- themagnitudeofthepullvarieswithintensity,durationandrangeofmovement….•AnalterationinalignmentthatincreasestheQ-Angleincreasestheresultantlateralforce[pull]onthepatellaandmaycausetendencyoforactualdisplacementwithresultantpainanddisability.

ImportanceofQ-Anglecontinued

•Apersonwithpatellaalta orexcessiveq-angleduetowidepelvisorgenuvalgum ispredisposedtolateraldisplacementofthepatella[Patelladysplasia]– Why?

RadiographoftheKneejoint[ShowingPatellaalta]

ImportanceofQ-Anglecontd.

•Genuvalgum increasestheobliquityofthefemurandconcomitantlytheobliquityofthepullofthequadricepsandconsequentlylateraldisplacementofthepatella.• TheincreasedpelvicwidthcontributestoinceasedQ-Agle andsportsinjuryrisksinwomen.• Inpatellaalta,theprotectionfromlateraldisplacementbythelaterallipofthegroove(forpatellatracking)ofthefemoralcondylesisrelativelylost.

ImportanceofQ-Anglecontd.

i

HighQ-Angleisalsoassociatedwith:•Femoralanteroversion•Externaltibial torsion- Footpronation•Laterallydisplacedtibial tubercle

ManagementforreductionofexcessiveQ-Angle

•Useofcustom-madefunctionalorthosis•Quadsisometric[strenghtening ]exerciseswithemphasisonvastusmedialis•Surgery

PatellaSupport

PatellaSupportasanOrthosis