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Comparative Goniometric Analysis of Tibial Torsion and Q-angle Between Sedentary Young Adults and Amateur Athletes: A
Kumari Ayushi1, PrajnaParamita Samanta1, Mamata Panigrahi1
1Anatomy, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Background:
Lower-limb alignment parameters, particularly tibial torsion and the quadriceps angle (Q-angle), are key determinants of patellofemoral mechanics. Their comparative profiles across different activity levels in young adults remain inadequately characterized. The 18-25-year age window was chosen because lower-limb skeletal alignment is mature by 18 years, while age-related degenerative knee changes are uncommon below 25 years, minimizing both developmental and degenerative confounding.
Objective:
To compare tibial torsion and Q-angle between sedentary young adults and amateur athletes aged 18-25 years and determine the influence of habitual physical activity on these lower extremity rotational alignment parameters.
Methods:
A cross-sectional study with prospective data collection was conducted at the Department of Anatomy, KIMS, in collaboration with the KIIT School of Physiotherapy, Bhubaneswar, between February 2024 and January 2026 after Institutional Ethics Committee approval (KIIT/KIMS/IEC/1510/2024). A total of 400 participants (200 sedentary, 200 amateur athletes; 100 males and 100 females per group) were recruited by convenience sampling with frequency matching of age and sex. Sedentary participants were operationally defined as performing less than 30 minutes of moderate-intensity physical activity per week and amateur athletes as performing at least three structured training sessions per week of 60 minutes or longer at a non-elite level. Q-angle and tibial torsion were measured by goniometry in the supine position by a single trained examiner; each measurement was repeated three times and averaged. Shapiro-Wilk testing demonstrated non-normal distributions, so variables are expressed as median with interquartile range (IQR), and groups were compared using the Mann-Whitney U test with rank-biserial correlation (r) as effect size; 95% CIs for medians were obtained by bias-corrected and accelerated bootstrap with 2000 resamples. Significance was set at p < 0.05.
Results:
Groups were age-matched (both medians 22 years; IQR 20-24; p = 0.901). Sedentary participants had higher BMIs (median 23.81 kg/m², IQR 21.2-26.9 vs. 22.98, IQR 20.0-25.2; p < 0.001, r = 0.20). The Q-angle was higher in sedentary than sports participants (median 16°, IQR 14-18 vs. 15°, IQR 13.7-16.4; p = 0.004, r = 0.17, small effect). Tibial torsion was markedly greater in sports than sedentary participants (median 20.9°, IQR 19.0-22.7 vs. 18°, IQR 17.0-19.2; p < 0.001, r = -0.63, large effect); bootstrap 95% CIs for the medians (20.1-21.3 vs. 18.0-18.3) did not overlap, and all values remained within the physiological range of 15-30°. Total leg length did not differ significantly between groups (median 91 cm, IQR 88-95.2 vs. 90 cm, IQR 88.3-92.6; p = 0.126).
Conclusions:
Regular sports participation is associated with a lower Q-angle (median difference ≈1°; small effect) and a markedly greater tibial torsion (median difference ≈3°; large effect) in young adults, reflecting activity-induced biomechanical adaptations. Elevated Q-angle in sedentary individuals may reflect higher patellofemoral loading, whereas increased tibial torsion in athletes represents adaptive rotational remodeling within physiological limits.
