pathomechanics of the knee - bowen university · the knee joint [revision] •knee is the largest...
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PST325:PATHOKINESIOLOGYPathomechanics oftheKnee
TheQ-AngleInstructors:ProfMOBOlaogun
Mrs JOAdeleke
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TheQuadricepsAngle[Q-Angle]
•WhatistheQuadricepsAngle?•Howisitmeasured?•Whyisitimportanttothephysiotherapist?•WhataretheNormalvalues?•Whatarethecausesofabnormalvalues?•Anyimplicationofabnormalvaluesinsporting/recreationalactivities?
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TheKneejoint[Revision]
•Kneeisthelargestjointinthebody• Involvedinapproximately50%ofmusculoskeletalinjuries….•3joints-•Tibiofemoral (2)•Patellofemoral
•Musclesandtendonsaroundthekneejoint[Assignment– NamesandNervesupply]•Accessoryquadriceps
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TheKneejointcontd
•Ligaments[Assignment- NamesandPositions]•Sessamoid bones•Patella•Fabella
•Theroleofthepatellaasapulley
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TheKneejointcontd.
Whataretheclinicalimplicationsof•PatellaAlta[Highriding]?•PatellaBaja[Lowriding]?
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RadiographoftheKneejoint
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Install-Salvati Ratio-HeightofPatella:Length ofLigamentum Patellae
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TheQ-Angle
•Anglebetweenthequadricepsmuscle(primarilyrectusfemoris)andthepatellaligament.
•Ameasureofpatellofemoral mechanics[Biomechanics]
•Acuteangleformedbythevectorforcombinedpullofthequadricepsmuscleandthepatellatendon
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•Angleformedbytheresultantforceofthequadricepsfemoris muscleonthebaseofthepatellaandthelineofpullofthepatellaligamentontheapexpfthepatella.•Measurementofpelvicwidththatisthoughttocontributetosportsinjuryrisksinwomen.
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HowisQ-Anglemeasured?
•Measuredasanangleformedbythelineconnectingtheanteriorsuperioriliacspine(ASIS)tothecenterofthepatellaandthelineconnectingthecenterofthepatellatothetipoftibial tuberosity(measuredwithagoniometer)•Estimatednormalvalueandgendervariation-14oinMenand17o Women[Seethetablebelow]
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Meaurement oftheKneejoint(Supine)
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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
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• *Omololu etal.,2009.[Studyof477Nigerianadults(354menand123women).StudyshowedthattheQ-angleinadultNigerianmeniscomparabletothatofadultcaucusian,butq-angleoftheNigerianwomengreaterthanthatoftheCaucasiancoutnerparts.
_________________________________________________________Omololu,BB…(2009) ;ClinicalOrthopaedicsandRelatedResearch,pp2073-2078.August2019.
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ImportanceofQ-Angle
Q-Angleisformedbythevectorforcombinedpullofthequadricepsfemoris musclesandthePatellatendonduringkneeextenion•Alateralpullisexertedonthepatella- themagnitudeofthepullvarieswithintensity,durationandrangeofmovement….•AnalterationinalignmentthatincreasestheQ-Angleincreasestheresultantlateralforce[pull]onthepatellaandmaycausetendencyoforactualdisplacementwithresultantpainanddisability.
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ImportanceofQ-Anglecontinued
•Apersonwithpatellaalta orexcessiveq-angleduetowidepelvisorgenuvalgum ispredisposedtolateraldisplacementofthepatella[Patelladysplasia]– Why?
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RadiographoftheKneejoint[ShowingPatellaalta]
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ImportanceofQ-Anglecontd.
•Genuvalgum increasestheobliquityofthefemurandconcomitantlytheobliquityofthepullofthequadricepsandconsequentlylateraldisplacementofthepatella.• TheincreasedpelvicwidthcontributestoinceasedQ-Agle andsportsinjuryrisksinwomen.• Inpatellaalta,theprotectionfromlateraldisplacementbythelaterallipofthegroove(forpatellatracking)ofthefemoralcondylesisrelativelylost.
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ImportanceofQ-Anglecontd.
i
HighQ-Angleisalsoassociatedwith:•Femoralanteroversion•Externaltibial torsion- Footpronation•Laterallydisplacedtibial tubercle
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ManagementforreductionofexcessiveQ-Angle
•Useofcustom-madefunctionalorthosis•Quadsisometric[strenghtening ]exerciseswithemphasisonvastusmedialis•Surgery
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PatellaSupport
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PatellaSupportasanOrthosis