Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2018

01-03-2018 | Knee

Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle–trochlear groove distance

Authors: Kristin H. Graf, Marc A. Tompkins, Julie Agel, Elizabeth A. Arendt

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2018

Login to get access

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.
Literature
1.
Apostolovic M, Vukomanovic B, Slavkovic N, Vuckovic V, Vukcevic M, Djuricic G, Kocev N (2011) Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop 35(10):1483–1487CrossRefPubMedPubMedCentral
2.
Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28(4):472–479CrossRefPubMed
3.
Biyani R, Elias JJ, Saranathan A, Feng H, Guseila LM, Morscher MA, Jones KC (2014) Anatomical factors influencing patellar tracking in the unstable patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 22(10):2334–2341CrossRefPubMed
4.
Brattström H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand Suppl 68:1–148CrossRef
5.
Brown DE, Alexander AH, Lichtman DM (1984) The Elmslie-Trillat procedure: evaluation in patellar dislocation and subluxation. Am J Sports Med 12(2):104–109CrossRefPubMed
6.
Calmbach WL, Hutchens M (2003) Evaluation of patients presenting with knee pain: part II. Differential diagnosis. Am Fam Physician 68(5):917–922PubMed
7.
Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17(1):11–16CrossRefPubMed
8.
Cooney AD, Kazi Z, Caplan N, Newby M, St Clair Gibson A, Kader DF (2012) The relationship between quadriceps angle and tibial tuberosity-trochlear groove distance in patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 20(12):2399–2404CrossRefPubMed
9.
Cox JS (1976) An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report. Am J Sports Med 4(2):72–77CrossRefPubMed
10.
Daynes J, Hinckel BB, Farr J (2016) Tibial tuberosity-posterior cruciate ligament distance. J Knee Surg 29(6):471–477CrossRefPubMed
11.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26CrossRefPubMed
12.
Dickschas J, Harrer J, Bayer T, Schwitulla J, Strecker W (2016) Correlation of the tibial tuberosity-trochlear groove distance with the Q-angle. Knee Surg Sports Traumatol Arthrosc 24(3):915–920CrossRefPubMed
13.
Freedman BR, Brindle TJ, Sheehan FT (2014) Re-evaluating the functional implications of the Q-angle and its relationship to in vivo patellofemoral kinematics. Clin Biomech (Bristol, Avon) 29(10):1139–1145CrossRef
14.
Goldthwait JE (1899) Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 29(1):62–68PubMedPubMedCentral
15.
Guilbert S, Chassaing V, Radier C, Hulet C, Remy F, Chouteau J, Chotel F, Boisrenoult P, Sebilo A, Ferrua P, Ehkirch FP, Bertin D, Dejour D, French Arthroscopy Society (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99(8 Suppl):S399–S405CrossRefPubMed
16.
Herrington L, Nester C (2004) Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella. Clin Biomech (Bristol, Avon) 19(10):1070–1073CrossRef
17.
Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of Q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5):715–724CrossRefPubMed
18.
Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Sudkamp NP, Niemeyer P (2014) Influence of knee flexion angle and weight bearing on the tibial tuberosity-trochlear groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc 22(11):2655–2661CrossRefPubMed
19.
Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol 161(1):109–113CrossRefPubMed
20.
Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18(4):359–365CrossRefPubMed
21.
Lee C-H, Wu C-C, Pan R-Y, Lu H-T, Shen H-C (2014) Medial retinacular flap advancement and arthroscopic lateral release for symptomatic chronic patellar lateral subluxation with tilting. Knee Surg Sports Traumatol Arthrosc 22(10):2499–2504CrossRefPubMed
22.
Livingston LA (1998) The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther 28(2):105–109CrossRefPubMed
23.
Merchant AC (2011) A philosophy of the patellofemoral joint: a logical clinical approach. In: Sanchis-Alfonso V (ed) Anterior knee pain and patellar instability, 2nd edn. Springer-Verlag, London, pp 519–530CrossRef
24.
Merchant AC, Mercer RL (1974) Lateral release of the patella. A preliminary report. Clin Orthop Relat Res 103:40–45CrossRef
25.
Miyazaki Y, Nakamura T, Kogame K, Saito M, Yamamoto K, Suguro T (2011) Analysis of the kinematics of total knee prostheses with a medial pivot design. J Arthroplasty 26(7):1038–1044CrossRefPubMed
26.
Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14(4):513–515CrossRefPubMed
27.
Roux C (1888) Luxation habituelle de la rotule. Traitement opératoire/[Recurrent dislocation of the patella. Operative treatment]. Rev Chir 8:682–689
28.
29.
Sanfridsson J, Arnbjornsson A, Friden T, Ryd L, Svahn G, Jonsson K (2001) Femorotibial rotation and the Q-angle related to the dislocating patella. Acta Radiol 42(2):218–224CrossRefPubMed
30.
Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31CrossRefPubMed
31.
Smith TO, Hunt NJ, Donell ST (2008) The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc 16(12):1068–1079CrossRefPubMed
32.
Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101CrossRefPubMed
33.
Tanaka MJ, Elias JJ, Williams AA, Carrino JA, Cosgarea AJ (2015) Correlation between changes in tibial tuberosity-trochlear groove distance and patellar position during active knee extension on dynamic kinematic computed tomographic imaging. Arthroscopy 31(9):1748–1755CrossRefPubMed
34.
Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H, Saito N (2015) What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am 97(17):1441–1448CrossRefPubMed
35.
Trillat A, Dejour H, Couette A (1964) Diagnosis and treatment of recurrent dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 50:813–824PubMed
36.
Wilson T, Kitsell F (2002) Is the Q-angle an absolute or a variable measure?: Measurement of the Q-angle over one minute in healthy subjects. Physiotherapy 88(5):296–302CrossRef
Metadata
Title
Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle–trochlear groove distance
Authors
Kristin H. Graf
Marc A. Tompkins
Julie Agel
Elizabeth A. Arendt
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4527-5

Other articles of this Issue 3/2018

Knee Surgery, Sports Traumatology, Arthroscopy 3/2018 Go to the issue

Shoulder

Return to sports after the latarjet procedure: high return level of non-collision athletes

Hip

Pudendal nerve injury is a relatively common but transient complication of hip arthroscopy

Hip

Gluteus maximus contraction velocity assessed by tensiomyography improves following arthroscopic treatment of femoroacetabular impingement

Ankle

Reliability and validation of the Dutch Achilles tendon Total Rupture Score

Sports Medicine

Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data

Knee

Quality assessment of radiological measurements of trochlear dysplasia; a literature review