Q Angle in Static and Dynamic Postures

NCT ID: NCT05894551

Last Updated: 2025-11-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

130 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-05-01

Study Completion Date

2023-07-15

Brief Summary

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The Q angle, also known as the quadriceps angle, is defined as the angle formed between the quadriceps muscles and the patella tendon. It was first described by Brattstrom in 1964 (1). The Q angle is the angle between the line extending from the anterior superior of the spina iliaca to the midpoint of the patella and the line extending from the midpoint of the patella to the tuberositas tibia (2). Normally, this angle is between 8-14 degrees in men and 11-20 degrees in women. Any alignment change that increases the Q angle is thought to increase the lateral force on the patella.

The Q angle is generally evaluated in static postures in the literature. The Q angle value varies according to the patient's gender, the contractility of the quadriceps, and the patient's posture (standing or supine) (3).

Q angle was evaluated in a static posture with a standard goniometer or computerized biophotogrammetry (4) Q angle changes with the forces applied by dynamic structures. It is insufficient to evaluate only in a static posture. Therefore, the aim of this study is to examine the effect of dynamic structures on the Q angle using 2D gait analysis (video) and to detect the early signs of deviation of changes in the q angle.

Detailed Description

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The Q angle is a very important tool in evaluating the function of the knee joint and describing the biomechanical alignment and function of the lower extremity (5). Abnormal values may cause joint problems later on, and in some cases, may affect the quadriceps reflex time, causing subluxation of the patella or an increased risk of developing anterior cruciate ligament ACL injury (5). For this reason, the Q angle is routinely and regularly used as an evaluation parameter when diagnosing many knee-related problems, including anterior knee pain, osteoarthritis, and degenerative knee disorders. When evaluated correctly, it provides very useful information about the alignment of the pelvis, legs and feet (6-8).

Therefore, determining the Q angle is very important, especially for athletic and physically active patients (9). In most studies, the Q angle was measured using a goniometer or with a modified goniometer (10-12). Biedert et al. by radiography (3). Braz et al. determined the Q angle with digital photogrammetry (13). In the literature, the q angle was generally evaluated in the supine or standing position (14). Higher Q angle values have been reported when transitioning from the supine position to the standing position (15). The increased Q angle while standing has been attributed to changes in lower extremity alignment due to weight bearing. In studies in the literature, the q angle was generally evaluated in static postures. In an ideal postural alignment, there should be a dynamic balance between muscles, joints and skeletal structures (16-17). Not only static structures but also dynamic structures are responsible for problems related to the alignment of the patella. For this reason, it is important to know the changes in the q angle not only in static postures but also in dynamic postures. Evaluation in correct postures is essential for diagnosis, planning and follow-up of the development and results of physical therapy (16).

The primary aim of this study was to report the prevalence and normative reference values of the q angle in the midstance phase of gait using 2D analysis (video).

The secondary aim of this study is to examine the variation of q angles during the midstance phase gait with Q angle values in static postures.

The tertiary aim of this study is to examine the relationship of q angles with different parameters such as age, gender, BMI, lower extremity strength, and hypermobility.

Demographic information (age, weight, height, etc.) will be obtained from healthy volunteers included in the study. As primary outcome measures, q-angles will be measured in static posture (supine and standing) and dynamic posture (with video analysis). Markers will be placed on the relevant places (SIAS, Patella middle and tuberositas tibia). Afterward, the video recordings will be played in slow motion and the evaluators will pause the video during the mid-stance phases of the gait, and the q-angles will be determined with the two-dimensional video analysis software (Kinoveav.0.8.15).

As secondary outcome measures, pelvis width and thigh length with a tape measure and femoral anteversion goniometer with quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength with hand-held dynamometer, joint mobility with Beighton score, foot posture index and functionality will be evaluated by walking 8 meters.

Conditions

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Quadriceps Muscle Orthopedic Disorder

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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healthy participants

Volunteers aged 18-25 years, healthy individuals without any spinal or neurologic injury and any injury leading to ligament, muscle or bone defect in their lower extremities

Evaluation of q angles different positions

Intervention Type OTHER

Q angle evaluation in two different static postures (upright and supine position) and dynamic posture during the midstance phase of the gait

Physical examination

Intervention Type OTHER

With goniometric evaluations, the femoral anteversion angle will be measured. Pelvis width and thigh length will be measured with a tape measure. Quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength will be measured with hand-held dynamometer.

Joint mobility will be assessed with the Beighton score and foot posture will be evaluated with the foot posture index-6 (FPI-6).

Functional mobility assessment

Intervention Type OTHER

10-meter walking test will be conducted to understand functional mobility.

Interventions

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Evaluation of q angles different positions

Q angle evaluation in two different static postures (upright and supine position) and dynamic posture during the midstance phase of the gait

Intervention Type OTHER

Physical examination

With goniometric evaluations, the femoral anteversion angle will be measured. Pelvis width and thigh length will be measured with a tape measure. Quadriceps muscle strength, hamstring muscle strength, Hip abduction, adduction, internal and external rotation and extension muscle strength will be measured with hand-held dynamometer.

Joint mobility will be assessed with the Beighton score and foot posture will be evaluated with the foot posture index-6 (FPI-6).

Intervention Type OTHER

Functional mobility assessment

10-meter walking test will be conducted to understand functional mobility.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* being between the ages of 18-25
* being volunteer
* not have any condition that may affect cooperation

Exclusion Criteria

* Individuals with any injury to their lower extremities that cause ligament, muscle or bone defect and any spinal or neurological injury
* individuals diagnosed with any knee disorder such as fracture, acute or chronic knee pain, patella dislocation
Minimum Eligible Age

18 Years

Maximum Eligible Age

25 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Istanbul University - Cerrahpasa

OTHER

Sponsor Role lead

Responsible Party

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Gokce Leblebici

Asssistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Istanbul University-Cerrahpaşa

Istanbul, Istanbul, Turkey (Türkiye)

Site Status

Hatay Mustafa Kemal University

Hatay, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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BRATTSTROEM H. SHAPE OF THE INTERCONDYLAR GROOVE NORMALLY AND IN RECURRENT DISLOCATION OF PATELLA. A CLINICAL AND X-RAY-ANATOMICAL INVESTIGATION. Acta Orthop Scand Suppl. 1964;68:SUPPL 68:1-148. No abstract available.

Reference Type BACKGROUND
PMID: 14171734 (View on PubMed)

Merchant AC, Fraiser R, Dragoo J, Fredericson M. A reliable Q angle measurement using a standardized protocol. Knee. 2020 Jun;27(3):934-939. doi: 10.1016/j.knee.2020.03.001. Epub 2020 Apr 12.

Reference Type BACKGROUND
PMID: 32295725 (View on PubMed)

Biedert RM, Warnke K. Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg. 2001 Jun;121(6):346-9. doi: 10.1007/s004020000239.

Reference Type BACKGROUND
PMID: 11482469 (View on PubMed)

Iunes DH, Castro FA, Salgado HS, Moura IC, Oliveira AS, Bevilaqua-Grossi D. Confiabilidade intra e interexaminadores e repetibilidade da avaliação postural pela fotogrametria. Rev Bras Fisioter. 2005;9(3):327-334.

Reference Type BACKGROUND

Khasawneh RR, Allouh MZ, Abu-El-Rub E. Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PLoS One. 2019 Jun 13;14(6):e0218387. doi: 10.1371/journal.pone.0218387. eCollection 2019.

Reference Type BACKGROUND
PMID: 31194851 (View on PubMed)

Daneshmandi H, Saki F, Shahheidari S, Khoori A. Lower extremity Malalignment and its linear relation with Q angle in female athletes. 3rd World Conf Educ Sci-2011. 2011;15: 3349-3354.

Reference Type BACKGROUND

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med. 2009 May;19(3):201-6. doi: 10.1097/JSM.0b013e3181a38fb1.

Reference Type BACKGROUND
PMID: 19423972 (View on PubMed)

Almeida GP, Silva AP, Franca FJ, Magalhaes MO, Burke TN, Marques AP. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Rev Bras Ortop. 2016 Feb 9;51(2):181-6. doi: 10.1016/j.rboe.2016.01.010. eCollection 2016 Mar-Apr.

Reference Type BACKGROUND
PMID: 27069887 (View on PubMed)

Yilmaz A, Kabadayi M, Mayda M, Çavusoglu G, Tasmektepligi M. Analysis of Q Angle Values of Female Athletes from Different Branches. Sci Mov Heal. 2017;17: 141-146.

Reference Type BACKGROUND

Omololu BB, Ogunlade OS, Gopaldasani VK. Normal Q-angle in an adult Nigerian population. Clin Orthop Relat Res. 2009 Aug;467(8):2073-6. doi: 10.1007/s11999-008-0637-1. Epub 2008 Nov 26.

Reference Type BACKGROUND
PMID: 19034592 (View on PubMed)

Greene CC, Edwards TB, Wade MR, Carson EW. Reliability of the quadriceps angle measurement. Am J Knee Surg. 2001 Spring;14(2):97-103.

Reference Type BACKGROUND
PMID: 11401177 (View on PubMed)

Raveendranath R, Nachiket S, Sujatha N, Priya R, Rema D. Bilateral Variability of the Quadriceps Angle (Q angle) in an Adult Indian Population. Iran J Basic Med Sci. 2011 Sep;14(5):465-71.

Reference Type BACKGROUND
PMID: 23493777 (View on PubMed)

Braz RG, Carvalho GA. Relationship between quadriceps angle (Q) and plantar pressure distribution in football players. Rev Bras Fisioter. 2010 Jul-Aug;14(4):296-302. Epub 2010 Sep 3. English, Portuguese.

Reference Type BACKGROUND
PMID: 20949230 (View on PubMed)

Choudhary R, Malik M, Aslam A, Khurana D, Chauhan S. Effect of various parameters on Quadriceps angle in adult Indian population. J Clin Orthop Trauma. 2019 Jan-Feb;10(1):149-154. doi: 10.1016/j.jcot.2017.11.011. Epub 2017 Nov 23.

Reference Type BACKGROUND
PMID: 30705551 (View on PubMed)

Guerra JP, Arnold MJ, Gajdosik RL. Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther. 1994 Apr;19(4):200-4. doi: 10.2519/jospt.1994.19.4.200.

Reference Type BACKGROUND
PMID: 8173567 (View on PubMed)

Rosario L.R. What is posture? a review of the literature in search of a definition. EC Orthopaedics. 2017;6(3):111-133.

Reference Type BACKGROUND

Sacco I.C.N., AlIbert S., Queiroz B.W., Pripas D., KlelIng I., Kimura A.A. Reliability of photogrammetry in relation to goniometry for postural lower limb assessment. Rev Bras Fisioterpp. 2007;11(5):411-417.

Reference Type BACKGROUND

Other Identifiers

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IstanbulUC_dynamicqangle

Identifier Type: -

Identifier Source: org_study_id

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