2017 ISAKOS Biennial Congress ePoster #1726

 

“Extended Q Angle”.A New Clinical Sign For Decide Right Technique For Extensor Mechanism Realignment

Ricardo D. Manilov, MD, Capital, San Juan ARGENTINA
Clinica Mercedario, Capital, San Juan, ARGENTINA

FDA Status Cleared

Summary

The extended Q angle is a new clinical sign that detect torsional disorders and help us to decide wich technique of distal extensor mechanism alignement perform in each patient considering the position ef the foot in relation to the knee cap facing the zenit at 30 degrees of knee flexion.We describe 2 types of extended Q angle: type 1:tt lateralization and typ 2: torsional disorder the foot is not

Abstract

“Extended Q Angle”.A New Clinical Sign for Decide Right Technique for Extensor Mechanism Realignment
Summary:
The patellofemoral disorders are one of the most frequent causes of consultation in orthopedics, and multiple etiological factors are described in the pathogenesis. A full physical examination is essential for detecting or influencing factors in each patient for treatment "a la carté". In the literature is usually considered the distal realignment of the extensor mechanysm as a synonymous for transposition of the tibial tuberosity;, however this concept does not include the rotational factors, one of the major destabilizing (usually forgotten) forces generator of patellofemoral joint. This paper presents a new clinical semiological sign handy described, that help us in deciding the distal realignment of the extensor apparatus. Where a vector is added over the Q classic angle from the lower pole of the patella and parallel to the tibial shaft and its relation to foot position . This sign is measured with 30 ° knee flexion, with the kneecaps facing the zenith. With this” extended Q angle”, when it is increased we can find 2 types of extended Q angle: Type 1:when the foot is aligned with the kneecap, that is lateralization of the tibial tuberosity (tt transfer is well indicated) and type 2: when the foot is not aligned with the kneecap (foot external rotated more then 15°), that tell us that there is a rotational disorder. After that in prone position we finish the physical exam looking the tigh-foot angle (for tibial disorder) and Staheli maneuver for femur torsional disorders).We used this simple clinical sign in our practice for ten years and that helped us to detect minor torsional disorder that are sufficient for pain and or instability in patellofemoral joint. So since we use this sign we are now performing more rotational osteotomies than transfering tibial tubercle, so we treat the etiologic cause of the increased Q angle,and we can choose the exact distal realignment technique considering biomechanics.
Keywords: q angle, extended q angle, patellofemoral semiological sign, patellofemoral algorithm, rotational osteotomy, distal realignment
Type of study: technical note.