The Journal of Bone and Joint Surgery, Vol 66, Issue 5 715-724, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact

HH Huberti and WC Hayes

Controlled bending moments were applied to twelve human cadaver knee joints using a special loading fixture that allowed variation of both the Q-angle and the flexion angle. The joints were tested at three different Q-angles (physiological, increased 10 degrees, and decreased 10 degrees) and five different angles of flexion (ranging from 20 to 120 degrees). Based on one-third of values in the literature for maximum voluntary isometric quadriceps moments, we applied resultant knee moments of 23.6, 30.7, 47.2, and 35.0 newton-meters at 20, 30, 60, and 90 degrees of flexion, respectively. Based on two-thirds of reported maximum moments, we applied 47.2 newton-meters at 120 degrees of flexion. Normal patellofemoral-contact pressures, measured with a pressure-sensitive film, were remarkably uniformly distributed (+/- 0.25 megapascal ), with approximately the same pressure on the lateral and medial patellar facets. The maximum contact force occurred at 90 degrees of flexion. Extrapolating our measurements to full in vivo moments, we estimated maximum contact forces of 4600 newtons , or approximately 6.5 times body weight. Tendofemoral contact at 120 degrees of knee flexion supported one-third of the total contact force on the patella. A 10-degree increase in the Q-angle resulted in increased peak pressures (an increase of 45 per cent at 20 degrees of flexion). A decrease in the Q-angle resulted in unloading of the vertical crest and, in some knees, of parts of the lateral facet. However, these decreases were always associated with increased peak pressures (50 per cent more at 20 degrees of flexion) at other locations.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				A. E. Tsakoniti, C. A. Stoupis, and S. I. Athanasopoulos Quadriceps cross-sectional area changes in young healthy men with different magnitude of Q angle J Appl Physiol, September 1, 2008; 105(3): 800 - 804. [Abstract] [Full Text] [PDF]

				J. D. Willson, S. Binder-Macleod, and I. S. Davis Lower Extremity Jumping Mechanics of Female Athletes With and Without Patellofemoral Pain Before and After Exertion Am. J. Sports Med., August 1, 2008; 36(8): 1587 - 1596. [Abstract] [Full Text] [PDF]

				T. M. Melegari, B. G. Parks, and L. S. Matthews Patellofemoral Contact Area and Pressure After Medial Patellofemoral Ligament Reconstruction Am. J. Sports Med., April 1, 2008; 36(4): 747 - 752. [Abstract] [Full Text] [PDF]

				E. J. McWalter, J. Cibere, N. J. MacIntyre, S. Nicolaou, M. Schulzer, and D. R. Wilson Relationship Between Varus-Valgus Alignment and Patellar Kinematics in Individuals with Knee Osteoarthritis J. Bone Joint Surg. Am., December 1, 2007; 89(12): 2723 - 2731. [Abstract] [Full Text] [PDF]

				W. M. Mihalko, Y. Boachie-Adjei, J. T. Spang, J. P. Fulkerson, E. A. Arendt, and K. J. Saleh Controversies and Techniques in the Surgical Management of Patellofemoral Arthritis J. Bone Joint Surg. Am., December 1, 2007; 89(12): 2788 - 2802. [Full Text] [PDF]

				H.-C. Shen, K.-H. Chao, G.-S. Huang, R.-Y. Pan, and C.-H. Lee Combined Proximal and Distal Realignment Procedures to Treat the Habitual Dislocation of the Patella in Adults Am. J. Sports Med., December 1, 2007; 35(12): 2101 - 2108. [Abstract] [Full Text] [PDF]

				S. R. Ward, M. R. Terk, and C. M. Powers Patella Alta: Association with Patellofemoral Alignment and Changes in Contact Area During Weight-Bearing J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1749 - 1755. [Abstract] [Full Text] [PDF]

				R. S. Hinman and K. M. Crossley Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis Rheumatology, July 1, 2007; 46(7): 1057 - 1062. [Abstract] [Full Text] [PDF]

				A. J. Ramappa, M. Apreleva, F. R. Harrold, P. G. Fitzgibbons, D. R. Wilson, and T. J. Gill The Effects of Medialization and Anteromedialization of the Tibial Tubercle on Patellofemoral Mechanics and Kinematics Am. J. Sports Med., May 1, 2006; 34(5): 749 - 756. [Abstract] [Full Text] [PDF]

				N. Upadhyay, S. R. Vollans, B. B. Seedhom, and R. W. Soames Effect of Patellar Tendon Shortening on Tracking of the Patella Am. J. Sports Med., October 1, 2005; 33(10): 1565 - 1574. [Abstract] [Full Text] [PDF]

				K. J. Saleh, E. A. Arendt, J. Eldridge, J. P. Fulkerson, T. Minas, and K. J. Mulhall Symposium. Operative Treatment of Patellofemoral Arthritis J. Bone Joint Surg. Am., March 1, 2005; 87(3): 659 - 671. [Full Text] [PDF]

				E. K. Nam and R. P. Karzel Mini-Open Medial Reefing and Arthroscopic Lateral Release for the Treatment of Recurrent Patellar Dislocation: A Medium-Term Follow-up Am. J. Sports Med., February 1, 2005; 33(2): 220 - 230. [Abstract] [Full Text] [PDF]

				M. Bohnsack, A. Wilharm, C. Hurschler, O. Ruhmann, C. Stukenborg-Colsman, and C. J. Wirth Biomechanical and Kinematic Influences of a Total Infrapatellar Fat Pad Resection on the Knee Am. J. Sports Med., December 1, 2004; 32(8): 1873 - 1880. [Abstract] [Full Text] [PDF]

				D. C. Fithian, E. W. Paxton, M. L. Stone, P. Silva, D. K. Davis, D. A. Elias, and L. M. White Epidemiology and Natural History of Acute Patellar Dislocation Am. J. Sports Med., July 1, 2004; 32(5): 1114 - 1121. [Abstract] [Full Text] [PDF]

				E. Witvrouw, L. Danneels, D. Van Tiggelen, T. M. Willems, and D. Cambier Open Versus Closed Kinetic Chain Exercises in Patellofemoral Pain: A 5-Year Prospective Randomized Study Am. J. Sports Med., July 1, 2004; 32(5): 1122 - 1130. [Abstract] [Full Text] [PDF]

				J. J. Elias, J. A. Cech, D. M. Weinstein, and A. J. Cosgrea Reducing the Lateral Force Acting on the Patella Does Not Consistently Decrease Patellofemoral Pressures Am. J. Sports Med., July 1, 2004; 32(5): 1202 - 1208. [Abstract] [Full Text] [PDF]

				R. B. Garretson III, L. I. Katolik, N. Verma, P. R. Beck, B. R. Bach, and B. J. Cole Contact Pressure at Osteochondral Donor Sites in the Patellofemoral Joint Am. J. Sports Med., June 1, 2004; 32(4): 967 - 974. [Abstract] [Full Text] [PDF]

				T. J. Gill, L. E. DeFrate, C. Wang, C. T. Carey, S. Zayontz, B. Zarins, and G. Li The Effect of Posterior Cruciate Ligament Reconstruction on Patellofemoral Contact Pressures in the Knee Joint Under Simulated Muscle Loads Am. J. Sports Med., January 1, 2004; 32(1): 109 - 115. [Abstract] [Full Text]

				S. Nakagawa, Y. Kadoya, A. Kobayashi, I. Tatsumi, N. Nishida, and Y. Yamano Kinematics of the Patella in Deep Flexion: Analysis with Magnetic Resonance Imaging J. Bone Joint Surg. Am., July 3, 2003; 85(7): 1238 - 1242. [Abstract] [Full Text] [PDF]

				R. S. Burnett and R. B. Bourne Indications for Patellar Resurfacing in Total Knee Arthroplasty J. Bone Joint Surg. Am., March 31, 2003; 85(4): 728 - 745. [Full Text] [PDF]

				U. Kandemir, M. Yazici, A. M. Alpaslan, and A. Surat Morphology of the Knee in Adult Patients with Neglected Developmental Dysplasia of the Hip J. Bone Joint Surg. Am., December 9, 2002; 84(12): 2249 - 2257. [Abstract] [Full Text] [PDF]

				S. V. Sekaran, M. L. Hull, and S. M. Howell Nonanatomic Location of the Posterior Horn of a Medial Meniscal Autograft Implanted in a Cadaveric Knee Adversely Affects the Pressure Distribution on the Tibial Plateau Am. J. Sports Med., January 1, 2002; 30(1): 74 - 82. [Abstract] [Full Text] [PDF]

				Y.-F. Hsieh, L. F. Draganich, S. H. Ho, and B. Reider The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on the Contact Characteristics of the Patellofemoral Joint Am. J. Sports Med., January 1, 2002; 30(1): 121 - 127. [Abstract] [Full Text] [PDF]

				R. Kuroda, H. Kambic, A. Valdevit, and J. T. Andrish Articular Cartilage Contact Pressure after Tibial Tuberosity Transfer: A Cadaveric Study Am. J. Sports Med., July 1, 2001; 29(4): 403 - 409. [Abstract] [Full Text] [PDF]

				Z. A. Cohen, H. Roglic, R. P. Grelsamer, J. H. Henry, W. N. Levine, V. C. Mow, and G. A. Ateshian Patellofemoral Stresses during Open and Closed Kinetic Chain Exercises: An Analysis Using Computer Simulation Am. J. Sports Med., July 1, 2001; 29(4): 480 - 487. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, Z. A. Cohen, W. N. Levine, G. A. Ateshian, and V. C. Mow Biomechanical and Topographic Considerations for Autologous Osteochondral Grafting in the Knee Am. J. Sports Med., March 1, 2001; 29(2): 201 - 206. [Abstract] [Full Text] [PDF]

				D. A. Dennis Periprosthetic Fractures Following Total Knee Arthroplasty J. Bone Joint Surg. Am., January 1, 2001; 83(1): 120 - 120. [Full Text]

				E. Witvrouw, R. Lysens, J. Bellemans, K. Peers, and G. Vanderstraeten Open Versus Closed Kinetic Chain Exercises for Patellofemoral Pain: A Prospective, Randomized Study Am. J. Sports Med., September 1, 2000; 28(5): 687 - 694. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, S. D. Kwak, G. A. Ateshian, W. H. Warden, J. R. Steadman, and V. C. Mow Effects of Patellar Tendon Adhesion to the Anterior Tibia on Knee Mechanics Am. J. Sports Med., September 1, 1998; 26(5): 715 - 724. [Abstract] [Full Text] [PDF]

				P. T. Simonian, P. S. Sussmann, T. L. Wickiewicz, G. A. Paletta, and R. F. Warren Contact Pressures at Osteochondral Donor Sites in the Knee Am. J. Sports Med., July 1, 1998; 26(4): 491 - 494. [Abstract] [Full Text] [PDF]

				Y.-F. Hsieh, L. F. Draganich, S. H. Ho, and B. Reider The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics Am. J. Sports Med., March 1, 1998; 26(2): 201 - 209. [Abstract] [Full Text] [PDF]

				D. B. O'NEILL Open Lateral Retinacular Lengthening Compared with Arthroscopic Release. A Prospective, Randomized Outcome Study J. Bone Joint Surg. Am., December 1, 1997; 79(12): 1759 - 69. [Abstract] [Full Text]

				D. C. AYERS, D. A. DENNIS, N. A. JOHANSON, and V. D. PELLEGRINI JR. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Common Complications of Total Knee Arthroplasty*{{dagger}} J. Bone Joint Surg. Am., February 1, 1997; 79(2): 278 - 311. [Full Text]

				E. A. Morgan, J. J. McElroy, J. D. DesJardins, D. D. Anderson, and R. N. Steensen The Effect of Intercondylar Notchplasty on the Patellofemoral Articulation Am. J. Sports Med., December 1, 1996; 24(6): 843 - 846. [Abstract] [PDF]

				D. C. Fithian, D. K. Mishra, P. F. Balen, M. L. Stone, and D. M. Daniel Instrumented Measurement of Patellar Mobility Am. J. Sports Med., September 1, 1995; 23(5): 607 - 615. [Abstract] [PDF]

				T. Muneta, H. Yamamoto, T. Ishibashi, S. Asahina, and K. Furuya Computerized Tomographic Analysis of Tibial Tubercle Position in the Painful Female Patellofemoral Joint Am. J. Sports Med., January 1, 1994; 22(1): 67 - 71. [Abstract] [PDF]

				L. A. Steinkamp, M. F. Dillingham, M. D. Markel, J. A. Hill, and K. R. Kaufman Biomechanical considerations in patellofemoral joint rehabilitation Am. J. Sports Med., June 1, 1993; 21(3): 438 - 444. [Abstract] [PDF]

				S. D. D'Agata, A. W. Pearsall IV, B. Reider, and L. F. Draganich An in vitro analysis of patellofemoral contact areas and pressures following procurement of the central one-third patellar tendon Am. J. Sports Med., March 1, 1993; 21(2): 212 - 219. [Abstract] [PDF]

				M. Eilerman, J. Thomas, and D. Marsalka The effect of harvesting the central one-third of the patellar tendon on patellofemoral contact pressure Am. J. Sports Med., December 1, 1992; 20(6): 738 - 741. [Abstract] [PDF]

				C. C. Teitz and R. M. Harrington Patellar stress fracture Am. J. Sports Med., December 1, 1992; 20(6): 761 - 765. [PDF]

				D. B. O'Neill, L. J. Micheli, and J. P. Warner Patellofemoral stress: A prospective analysis of exercise treatment in adolescents and adults Am. J. Sports Med., March 1, 1992; 20(2): 151 - 156. [Abstract] [PDF]

				L. H. Woodland and R. S. Francis Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions Am. J. Sports Med., March 1, 1992; 20(2): 208 - 211. [Abstract] [PDF]

				K. R. Kaufman, K.-N. An, W. J. Litchy, B. F. Morrey, and E. Y.S. Chao Dynamic joint forces during knee isokinetic exercise Am. J. Sports Med., June 1, 1991; 19(3): 305 - 316. [Abstract] [PDF]

				M. L. Voight and D. L. Wieder Comparative reflex response times of vastus medialis obliquus and vastus lateralis in normal subjects and subjects with extensor mechanism dysfunction: An electromyographic study Am. J. Sports Med., March 1, 1991; 19(2): 131 - 137. [Abstract] [PDF]