Changes in dynamic quadriceps angle in patients with chronic ankle instability
Cross sectional observational study
Keywords:
Ankle, Joint Instability, Dynamic Q angle, DKV, FPPA, Biomechanical PhenomenaAbstract
Background: Changes in dynamic Quadriceps Angle (Q angle) had been studied in healthy subjects and individuals with other musculoskeletal disorders; however, in chronic ankle instability (CAI), it has not yet been determined. The purpose of this study was to investigate the difference in dynamic Q angle of patients with unilateral chronic ankle instability and those without chronic ankle instability. Methods: One-hundred and four participants with and without chronic ankle instability from both genders aged between 18-30 years, with a BMI range of 17.9-27.3, were enrolled into 2 equal groups; a study group and a control group, with mean values of age of the study and control groups (20.8±2.4) and (20.9±3) years respectively and of BMI (24.1±4.3) and (23.8±2.9) kg/m2 respectively. Dynamic Q angle measurement is carried out using dynamic knee valgus (DKV) through the frontal plane projection angle (FPPA) during single limb squat. Results: A statistically significant difference in FPPA angle was observed between the affected limb of the CAI group and controls (P=0.001). Conclusion: The present study suggested that unilateral CAI display an increased knee valgus, suggesting an additional proximal kinematic alteration and chronic maladaptation in the CAI population.
Downloads
References
Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. Am J Sports Med. 2016;44(4):995-1003. doi: 10.1177/0363546516628870 pmid: 26912285
Tajdini, H., Mantashloo, Z., Thomas, A.C. et al. Inter-limb asymmetry of kinetic and electromyographic during walking in patients with chronic ankle instability. Sci Rep 12, 3928 (2022). https://doi.org/10.1038/s41598-022-07975-x
Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of low ankle sprains. Br J Sports Med. 2016;50(24):1496-1505. doi: 10.1136/bjsports-2016-096189 pmid:27259753
Hertel, J. (2008). Sensorimotor deficits with ankle sprains and chronic ankle instability. Clinics in Sports Medicine, 27(3), 353–370. https://doi.org/10.1016/j.csm.2008.03.006
Simpson JD, Rendos NK, Stewart EM, Turner AJ, Wilson SJ, Macias DM, et al. Bilateral spatiotemporal postural control impairments are present in participants with chronic ankle instability. Physical Therapy in Sport. 2019; 39:1–7. https://doi.org/10.1016/j.ptsp.2019.06.002 PMID: 31202142
Karimi, K., Seidi, F., Mousavi, S. H., Alghosi, M., & Morad, N. H. (2023). Comparison of postural sway in individuals with and without Dynamic knee valgus. BMC Sports Science, Medicine and Rehabilitation, 15(1). https://doi.org/10.1186/s13102-023-00686-4
Skouras A Z, Kanellopoulos A K, Stasi S, et al. (May 11, 2022) Clinical Significance of the Static and Dynamic Q-angle. Cureus 14(5): e24911. doi:10.7759/cureus.24911
Zhu, Z., Zhang, Y., Shao, H., Ding, H., Wang, G. (2013). An in Vivo Study of the Dynamic Q Angle of the Knee Joint during Flexion. In: Long, M. (eds) World Congress on Medical Physics and Biomedical Engineering May 26-31, 2012, Beijing, China. IFMBE Proceedings, vol 39. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29305-4_63
Melicharek, Andrea, et al. “A COMPARISON OF THE BILATERAL, DYNAMIC Q-ANGLE IN FEMALES.” Portuguese Journal of Sport Sciences, 2011.
De Oliveira Silva, Danilo & Briani, Ronaldo & Pazzinatto, Marcella & Gonçalves, Ana & Ferrari, Deisi & Aragão, Fernando & Azevedo, Fábio. (2015). Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain?. Clinical biomechanics (Bristol, Avon). 30. 10.1016/j.clinbiomech.2015.09.002
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492-501. https://doi. org/10.1177/0363546504269591
Gait Analysis: Normal and Pathological Function. J Sports Sci Med. 2010 Jun 1;9(2):353. PMCID: PMC3761742.
Schurr SA, Marshall AN, Resch JE, Saliba SA. TWO-DIMENSIONAL VIDEO ANALYSIS IS COMPARABLE TO 3D MOTION CAPTURE IN LOWER EXTREMITY MOVEMENT ASSESSMENT. Int J Sports Phys Ther. 2017 Apr;12(2):163-172. PMID: 28515970; PMCID: PMC5380858.
Craig R. Gwynne, Sarah A. Curran , Two-dimensional frontal
plane projection angle can identify subgroups of patellofemoral pain patients who
demonstrate dynamic knee valgus. Jclb (2018), doi:10.1016/j.clinbiomech.2018.06.021
Willson JD, Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech (Bristol, Avon). 2008 Feb;23(2):203-11. doi: 10.1016/j.clinbiomech.2007.08.025. Epub 2007 Oct 17. PMID: 17942202.
Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Spec. 2014;7(1):37-44. doi: 10.1177/1938640013509670 pmid: 24287210
Letafatkar, A., Zandi, S., Khodaei, M., & Belali, J. (2013). Flat foot deformity, Q angle and knee pain are interrelated in wrestlers. Journal of Novel Physiotherapies, 03(02). https://doi.org/10.4172/2165-7025.1000138
Emami MJ, Ghahramani MH, Abdinejad F, Namazi H. Q-angle: an invaluable parameter for evaluation of anterior knee pain. Arch Iran Med. 2007 Jan;10(1):24-6. PMID: 17198449.
Anwer, N., Manzoor, N., Kiran, Q., Saleem, M., Fatima, S. A., & Rehan, A. (2022). Quadriceps femoral angle (Q angle) variations in knee osteoarthritis patients. Pakistan Journal of Medical and Health Sciences, 16(9), 627–629. https://doi.org/10.53350/pjmhs22169627
Docherty C, Gansneder B, Arnold B, Hurwitz S. Development and reliability of the ankle instability instrument. J Athl Train.2006;41(2):154–158.
Li, Y., Tsang, R. C.-C., Liu, D., Ruan, B., Yu, Y., & Gao, Q. (2021). Applicability of cutoff scores of Chinese Cumberland ankle instability tool and foot and ankle ability measure as inclusion criteria for study of chronic ankle instability in Chinese individuals. Physical Therapy in Sport, 48, 116–120. https://doi.org/10.1016/j.ptsp.2020.12.021
Abd El-Raheem R., Kamel R. and Ali M. (2015): Reliability of Using Kinovea Program in Measuring Dominant Wrist Joint Range of Motion. Trends in Applied Sciences Research, 10 (4): 224-230.
Llurda-Almuzara, L., Pérez-Bellmunt, A., López-de-Celis, C. et al. Normative data and correlation between dynamic knee valgus and neuromuscular response among healthy active males: a cross-sectional study. Sci Rep 10, 17206 (2020). https://doi.org/10.1038/s41598-020-74177-8
Willson JD, Ireland ML, Davis I (2006). Core strength and lower extremity alignment during single leg squats. Medicine & Science in Sports & Exercise; 38(5):945- 952
Willson JD, Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech (Bristol, Avon). 2008 Feb;23(2):203-11. doi: 10.1016/j.clinbiomech.2007.08.025. Epub 2007 Oct 17. PMID: 17942202.
Bartlett R Bussey M Flyger N Movement variability cannot be determined reliably from no‐marker conditions. J Biomech. 2006; 39:3076‐3079. [PubMed] [Google Scholar]
Willson JD Davis I Utility of the frontal plane projection angle in females with patellofemoral pain. J Ortho Sports Phys Ther. 2008b; 36:606‐615. [PubMed] [Google Scholar]
Ziaei Ziabari E, Haghpanahi M, Razi M, Lubberts B, Ashkani-Esfahani S, DiGiovanni CW. The Effects of Chronic Ankle Instability on the Biomechanics of the Uninjured, Contralateral Ankle During Gait. Orthop Surg. 2022 Sep;14(9):2238-2244. doi: 10.1111/os.13307. Epub 2022 Jul 19. PMID: 35852096; PMCID: PMC9483063.
Gwynne CR, Curran SA. Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures. Int J Sports Phys Ther. 2014 Dec;9(7):898-906. PMID: 25540705; PMCID: PMC4275194.
Willson JD, Davis IS. Utility of the frontal plane projection angle in females with patellofemoral pain. J Orthop Sports Phys Ther. 2008 Oct;38(10):606-15. doi: 10.2519/jospt.2008.2706. PMID: 18827327.
Afanador, D. F., Gómez-Rodas, A., & Baena-Marín, M. (2022). Análisis cinemático del ángulo de Proyección frontal de Rodilla en 2d: Enfoque metodológico. Revista Iberoamericana de Ciencias de La Actividad Física y El Deporte, 11(3), 98–115. https://doi.org/10.24310/riccafd.2022.v11i3.15370
Lopes TJA, Ferrari D, Ioannidis J, Simic M, Mícolis de Azevedo F, Pappas E. Reliability and Validity of Frontal Plane Kinematics of the Trunk and Lower Extremity Measured With 2-Dimensional Cameras During Athletic Tasks: A Systematic Review With Meta-analysis. The journal of orthopaedic and sports physical therapy. 2018;48(10):812-22.
Kingston B, Murray A, Norte GE, Glaviano NR. Validity and reliability of 2- dimensional trunk, hip, and knee frontal plane kinematics during single-leg squat, drop jump, and single-leg hop in females with patellofemoral pain. Physical therapy in sport. 2020;45:181-7.
Hansen R, Lundgaard-Nielsen M, Henriksen M (2021). Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study. PeerJ 9:e12203.
Zamani Moghadam H, Hoseini S T, Hashemian A, Sharifi M. The Relation of Q Angle and Anthropometric Measures with Ankle Sprain; a Case-control study. Emergency. 2017; 5 (1): e9.
Daneshmandi, H., Saki, F., Shahheidari, S., & Khoori, A. (2011). Lower extremity malalignment and its linear relation with Q angle in female athletes. Procedia - Social and Behavioral Sciences, 15, 3349–3354. https://doi.org/10.1016/j.sbspro.2011.04.298
Abdelhaleem, M. D., Grase, M. O., Aly, S. M., & Abdallah, E. A. (2022). Association between unilateral functional ankle instability, limited ankle dorsiflexion range of motion and low back pain. SPORT TK-Revista EuroAmericana de Ciencias Del Deporte, 47. https://doi.org/10.6018/sportk.526661
Tahoon, A. M., Abdelmageed, S. F., & Mosaad, D. M. (2022). The mechanical relation between chronic ankle instability and pelvic alignment: A matched case-control study. Annals of Applied Sport Science, 10(4), 0–0. https://doi.org/10.52547/aassjournal.1076
Pefanis, N., Papaharalampous, X., Tsiganos, G., Papadakou, E., & Baltopoulos, P. (2009). The effect of Q angle on ankle sprain occurrence. Foot & Ankle Specialist, 2(1), 22–26. https://doi.org/10.1177/1938640008330769.
Drewes LK, McKeon PO, Paolini G, Riley P, Kerrigan DC, Ingersoll CD, et al. Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability. J Sport Rehabil. 2009;18(3):375- 388. doi: 10.1123/jsr.18.3.375 pmid: 19827501
Lin, C.-I., Khajooei, M., Engel, T., Nair, A., Heikkila, M., Kaplick, H., & Mayer, F. (2021). The effect of chronic ankle instability on muscle activations in lower extremities. PLOS ONE, 16(2). https://doi.org/10.1371/journal.pone.0247581
Son SJ, Kim H, Seeley MK, Hopkins JT. Altered Walking Neuromechanics in Patients With Chronic Ankle Instability. J Athl Train. 2019; 54(6):684–97. https://doi.org/10.4085/1062-6050-478-17 PMID: 31162941.
DeJong, A. F., Mangum, L. C., & Hertel, J. (2019). Gluteus medius activity during gait is altered in individuals with chronic ankle instability: An ultrasound imaging study. Gait & Posture, 71, 7–13. https://doi.org/10.1016/j.gaitpost.2019.04.007
McCann RS, Crossett ID, Terada M, Kosik KB, Bolding BA, Gribble PA. Hip strength and star excursion balance test deficits of patients with chronic ankle instability. J Sci Med Sport. 2017 Nov;20(11):992-996. doi: 10.1016/j.jsams.2017.05.005. Epub 2017 May 25. PMID: 28595864.
Stickler L, Finley M, Gulgin H. Relationship between hip and core strength and frontal plane alignment during a single leg squat. Phys Ther Sport. 2015;16(1):66-71.
Koldenhoven RM, Feger MA, Fraser JJ, Saliba S, Hertel J. Surface electromyography and plantar pressure during walking in young adults with chronic ankle instability. Knee Surg Sport Tr A. 2016; 24 (4):1060–70. https://doi.org/10.1007/s00167-016-4015-3 PMID: 26856315
Koshino Y, Ishida T, Yamanaka M, Ezawa Y, Okunuki T, Kobayashi T, et al. Kinematics and muscle activities of the lower limb during a side-cutting task in subjects with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 2016; 24(4):1071–80. https://doi.org/10.1007/s00167-015-3745-y PMID: 26254794.
Palmieri-Smith, R. M., Wojtys, E. M., & Ashton-Miller, J. A. (2008). Association between preparatory muscle activation and peak valgus knee angle. Journal of Electromyography and Kinesiology, 18(6), 973–979. https://doi.org/10.1016/j.jelekin.2007.03.007
Li, Y., Ko, J., Walker, M. A., Brown, C. N., Schmidt, J. D., Kim, S.-H., & Simpson, K. J. (2018). Does chronic ankle instability influence lower extremity muscle activation of females during landing? Journal of Electromyography and Kinesiology, 38, 81–87. doi:10.1016/j.jelekin.2017.11.009
Sedory EJ, Mcvey ED, Cross KM, Ingersoll CD, Hertel J. Arthrogenic muscle response of the quadriceps and hamstrings with chronic ankle instability. J Athl Train. 2007;42(3):355-360. 29.Dorman T, Brierly S, Fray J, Pappani K. Muscles and Pelvic Gears : Hip abduct
Wild C.Y., Steele J.R., Munro B.J. Insufficient hamstring strength compromises landing technique in adolescent girls. Med. Sci. Sports Exerc. 2013;45:497–505. doi: 10.1249/MSS.0b013e31827772f6. [PubMed] [CrossRef] [Google Scholar]
Wilson J.D., Ireland M.L., Davis I. Core Strength and Lower Extremity Alignment during Single Leg Squats. Med. Sci. Sports Exerc. 2006;38:5. doi: 10.1249/01.mss.0000218140.05074.fa. [PubMed] [CrossRef] [Google Scholar]
Wilczyński, B.; Zorena, K.; Ślęzak, D. Dynamic Knee Valgus in Single-Leg Movement Tasks. Potentially Modifiable Factors and Exercise Training Options. A Literature Review. Int. J. Environ. Res. Public Health 2020, 17, 8208. https://doi.org/10.3390/ijerph17218208
Hertel J. Functional instability following lateralankle sprain. Sports Med. 2000;29(5):361-371.
Hoch MC, Staton GS, Medina McKeon JM, MattacolaCG, McKeon PO. Dorsiflexion and dynamic posturalcontrol deficits are present in those with chronicankle instability. J Sci Med Sportt. 2012;15(6)574-579.
Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):572-588. doi: 10.4085/1062-6050-344-18. Epub 2019 Jun 4. PMID: 31162943; PMCID: PMC6602403.
Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. Phys Ther Sport. 2018 Jan;29:61-69. doi: 10.1016/j.ptsp.2017.07.003. Epub 2017 Jul 19. PMID: 28974358.
Sedory EJ, Mcvey ED, Cross KM, Ingersoll CD, Hertel J. Arthrogenic muscle response of the quadriceps and hamstrings with chronic ankle instability. J Athl Train. 2007;42(3):355-360. 29.Dorman T, Brierly S, Fray J, Pappani K. Muscles and Pelvic Gears : Hip abduct
Schmidt E, Harris-Hayes M, Salsich GB. Dynamic knee valgus kinematics and their relationship to pain in women with patellofemoral pain compared to women with chronic hip joint pain. J Sport Health Sci. 2019 Sep;8(5):486-493. doi: 10.1016/j.jshs.2017.08.001. Epub 2017 Aug 18. PMID: 31511797; PMCID: PMC6738932.
Published
How to Cite
Issue
Section
Copyright (c) 2024 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.








