CLINICAL SIGNIFICANCE OF Q-ANGLE UNDER DIFFERENT CONDITIONS IN RECURRENT PATELLAR DISLOCATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGZhijie ^1,2 ,  CHENYou ¹ , LIAnping ¹ , LONGYi ¹

1. Department of Orthopedics, the Second Xiangya Hospital of Central South University, Changsha Hunan, 410011, P. R. China;
2. Department of Orthopedics, Jinjiang City Hospital;

Corresponding author：

CHENYou, Email: Chenyou137y@sina.com

Keywords：

Recurrent patellar dislocation; Q-angle; Diagnosis; Female patient

DOI：

10.7507/1002-1892.20140004

Video：

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Objective To investigate the clinical significance of Q-angle measuring under different conditions in female recurrent patellar dislocation female patients. Methods Between August 2012 and March 2013, 10 female patients (11 knees) with recurrent patellar dislocation were collected as trial group; 20 female patients (20 knees) with simple meniscus injury were collected as control group at the same time. Q-angle was measured in extension, 30° flexion, 30° flexion with manual correction, and surgical correction in the trial group, and only in extension and 30° flexion in the control group. Then the difference value of Q-angle between extension and 30° flexion (Q-angle in extension subtracts Q-angle in 30 flexion) were calculated. Independent sample t-test was used to analyze Q-angle degrees in extension, 30° flexion, and the changed degrees of 2 groups. The Q-angle between manual correction and surgical correction of the trial group was analyzed by paired t-test. Results The Q-angle in extension, Q-angle in 30° flexion, and difference value of Q-angle between extension and 30° flexion were (17.2±3.6), (14.3±3.0), and (2.9±1.9)° in the trial group and were (15.2±3.4), (14.4±3.5), and (0.8±1.7)° in the control group. No significant difference was found in Q-angle of extension or Q-angle of 30° flexion between 2 groups (P>0.05), but the difference value of Q-angle between extension and 30° flexion in the trial group was significantly larger than that in the control group (t=3.253, P=0.003). The Q-angle in 30° flexion with manual correction and surgical correction in the trial group was (19.8±3.4)° and (18.9±3.8)° respectively, showing no significant difference (t=2.193, P=0.053). Conclusion When a female patient's Q-angle in 30° flexion knee changes obviously compared with Q-angle in extension position, recurrent patellar dislocation should be considered. For female patients with recurrent patellar dislocation, the preoperative Q-angle in 30° flexion with manual correction should be measured, which can help increasing the accuracy of evaluation whether rearrangement should be performed.

Citation： WANGZhijie, CHENYou, LIAnping, LONGYi. CLINICAL SIGNIFICANCE OF Q-ANGLE UNDER DIFFERENT CONDITIONS IN RECURRENT PATELLAR DISLOCATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 17-20. doi: 10.7507/1002-1892.20140004 Copy

1.	Fithian DC,Paxton EW,Stone ML,et al.Epidemiology and natural history of acute patellardislocation.Am J Sports Med,2004,32(5):1114-1121.
2.	Atkin DM,Fithian DC,Marangi KS,et al.Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.Am J Sports Med,2000,28(4):472-479.
3.	Sanfridsson J,Ambjömsson A,Fridén T,et al.Femorotibial rotation and the Q-angle related to the dislocating patella.Acta Radiol,2001,42(2):218-224.
4.	Bellemans J,Cauwenberghs F,Witvrouw E,et al.Anteromedial tibial tuberlce transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment.Am J Sports Med,1997,25(3):375-381.
5.	Herrington L,Nester C.Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella.Clin Biomech (Bristol,Avon),2004,19(10):1070-1073.
6.	Canale ST,Beaty JH.坎贝尔骨科手术学.王岩,译.11版.北京:人民军医出版社,2011:2076-2090.
7.	陈世益,袁旬华,丁祖泉,等.膝关节Q角变化规律的实验研究.中国运动医学杂志,1997,16(2):91-94.
8.	邱玲,郑旭,袁松柏.Q角的理论与临床应用思考.中国康复,2009,24(4):275-276.
9.	Sillanpää PJ,Peltola E,Mattila VM,et al.Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men.Am J Sports Med,2009,37(8):1513-1521.
10.	Weber-Spickschen TS,Spang J,Kohn L,et al.The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation:an MRI evaluation.Knee,2011,18(3):185-188.
11.	Merican AM,Aims AA.Anatomy of the lateral retinaculum of the knee.J Bone Joint Surg (Br),2008,90(4):527-534.
12.	陈世益,范振华,许胜文,等.排球运动员髌骨软骨软化症与Q角关系的研究:Ⅰ.临床流行病学研究.中国运动医学杂志,1991,10(4):193-198.
13.	White BJ,Sherman OH.Patellofemoral instability.Bull NYU Hosp Jt Dis,2009,67(1):22-29.
14.	Mizuno Y,Kumagai M,MattesIeh SM,et al.Q-angle influences tibiofemoral and patellofemoral kinematics.J Orthop Res,2001,19(5):834-840.
15.	Palmu S,Kallio PE,Donell ST,et al.Acute patellar dislocation in children and adolescents:a randomized clinical trial.J Bone Joint Surg (Am),2008,90(3):463-470.
16.	周红星,李钦宗,张保健,等.关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位.中国修复重建外科杂志,2012,26(6):683-685.
17.	张辉,洪雷,耿向苏,等.内侧髌股韧带重建治疗复发性髌骨脱位.中国修复重建外科杂志,2011,25(8):925-930.
18.	Marsh JS,Daigneault JP,Sethi P,et al.Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique.J Pediatr Orthop,2006,26(4):461-465.
19.	Kuroda R,Kambic H,Valdevit A,et al.Articular cartilage contact pressure after tibial tuberosity transfer.A cadaveric study.Am J Sports Med,2001,29(4):403-409.
20.	Post WR,Teitge RR,Amis A.Patellofemoral malalignment:looking beyond the viewboxs.Clin Sports Med,2002,21(3):521-546.
21.	Fithian DC,Mishra DK,Balen PF,et al.Instrumented measurement of patella mobility.Am J Sports Med,1995,23(5):607-615.

1. Fithian DC,Paxton EW,Stone ML,et al.Epidemiology and natural history of acute patellardislocation.Am J Sports Med,2004,32(5):1114-1121.
2. Atkin DM,Fithian DC,Marangi KS,et al.Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.Am J Sports Med,2000,28(4):472-479.
3. Sanfridsson J,Ambjömsson A,Fridén T,et al.Femorotibial rotation and the Q-angle related to the dislocating patella.Acta Radiol,2001,42(2):218-224.
4. Bellemans J,Cauwenberghs F,Witvrouw E,et al.Anteromedial tibial tuberlce transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment.Am J Sports Med,1997,25(3):375-381.
5. Herrington L,Nester C.Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella.Clin Biomech (Bristol,Avon),2004,19(10):1070-1073.
6. Canale ST,Beaty JH.坎贝尔骨科手术学.王岩,译.11版.北京:人民军医出版社,2011:2076-2090.
7. 陈世益,袁旬华,丁祖泉,等.膝关节Q角变化规律的实验研究.中国运动医学杂志,1997,16(2):91-94.
8. 邱玲,郑旭,袁松柏.Q角的理论与临床应用思考.中国康复,2009,24(4):275-276.
9. Sillanpää PJ,Peltola E,Mattila VM,et al.Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men.Am J Sports Med,2009,37(8):1513-1521.
10. Weber-Spickschen TS,Spang J,Kohn L,et al.The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation:an MRI evaluation.Knee,2011,18(3):185-188.
11. Merican AM,Aims AA.Anatomy of the lateral retinaculum of the knee.J Bone Joint Surg (Br),2008,90(4):527-534.
12. 陈世益,范振华,许胜文,等.排球运动员髌骨软骨软化症与Q角关系的研究:Ⅰ.临床流行病学研究.中国运动医学杂志,1991,10(4):193-198.
13. White BJ,Sherman OH.Patellofemoral instability.Bull NYU Hosp Jt Dis,2009,67(1):22-29.
14. Mizuno Y,Kumagai M,MattesIeh SM,et al.Q-angle influences tibiofemoral and patellofemoral kinematics.J Orthop Res,2001,19(5):834-840.
15. Palmu S,Kallio PE,Donell ST,et al.Acute patellar dislocation in children and adolescents:a randomized clinical trial.J Bone Joint Surg (Am),2008,90(3):463-470.
16. 周红星,李钦宗,张保健,等.关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位.中国修复重建外科杂志,2012,26(6):683-685.
17. 张辉,洪雷,耿向苏,等.内侧髌股韧带重建治疗复发性髌骨脱位.中国修复重建外科杂志,2011,25(8):925-930.
18. Marsh JS,Daigneault JP,Sethi P,et al.Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique.J Pediatr Orthop,2006,26(4):461-465.
19. Kuroda R,Kambic H,Valdevit A,et al.Articular cartilage contact pressure after tibial tuberosity transfer.A cadaveric study.Am J Sports Med,2001,29(4):403-409.
20. Post WR,Teitge RR,Amis A.Patellofemoral malalignment:looking beyond the viewboxs.Clin Sports Med,2002,21(3):521-546.
21. Fithian DC,Mishra DK,Balen PF,et al.Instrumented measurement of patella mobility.Am J Sports Med,1995,23(5):607-615.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL SIGNIFICANCE OF Q-ANGLE UNDER DIFFERENT CONDITIONS IN RECURRENT PATELLAR DISLOCATION

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