In vitro characterization of the relationship between the Q-angle and the lateral component of the quadriceps force

Although the Q-angle is routinely measured, the relationship between the Q-angle and the lateral component of the quadriceps force acting on the patella is unknown. Five cadaver knees were flexed on a knee simulator with a normal Q-angle, and flexed after increasing and decreasing the Q-angle by shifting the quadriceps origin laterally and medially, respectively. The motion of the femur, tibia and patella was tracked from 20 to 90 degrees of flexion using electromagnetic sensors. The motion of landmarks used to quantify the Q-angle was tracked to determine the 'dynamic Q-angle' during flexion. The lateral component of the force applied by the actuator secured to the quadriceps tendon was also quantified throughout flexion. Increasing the initial Q-angle significantly (p < 0.05) increased the dynamic Q-angle and the lateral force exerted through the quadriceps tendon throughout flexion. Decreasing the initial Q-angle significantly decreased the dynamic Q-angle at 90 degrees of flexion and significantly decreased the lateral force exerted through the quadriceps tendon from 20 to 40 degrees of flexion. Even though the dynamic Q-angle changes during flexion, an abnormally large initial Q-angle can be an indicator of an abnormally large lateral force acting on the patella during flexion.