Year: 2026 | Month: November | Volume: 13 | Issue: 11 | Pages: 97-105
DOI: https://doi.org/10.52403/ijrr.20261109
Association of Patellofemoral Malalignment and Q Angle Alteration with Knee Pain: A Cross-sectional Observational Study
Dr. Sweta Upadhyay1, Dr. Kaushikkumar Patel2, Dr. Dimple Patel3
1Associate Professor, NAMO College of Allied Health Sciences, Silvassa, Dadra and Nagar Haveli, India.
2Professor, NAMO College of Allied Health Sciences, Silvassa, Dadra and Nagar Haveli, India.
3Principal and Professor, NAMO College of Allied Health Sciences, Silvassa, Dadra and Nagar Haveli, India.
Corresponding Author: Dr. Kaushikkumar Patel
ABSTRACT
Background: Patellofemoral malalignment has been implicated in the development of anterior knee pain, yet the role of clinical parameters such as the quadriceps (Q) angle remains debated. Given the high burden of knee pain and osteoarthritis (OA) in India, with prevalence estimates ranging between 18.3% to 33.2% across populations, identifying modifiable anatomical risk factors is critical.
Objectives: The primary objective of this study was to compare patellofemoral alignment characteristics and Q angle between individuals with knee pain and age- and gender-matched asymptomatic controls. A secondary objective was to explore the correlation between altered Q angle and the severity of knee pain.
Methods: A cross-sectional observational study was conducted involving 200 participants (100 with clinically diagnosed knee pain and 100 healthy controls). Demographic and anthropometric data were collected. Clinical Q angle was measured using a goniometer, while radiographic assessments included congruence angle, sulcus angle, patellar tilt, patellar height (Insall–Salvati ratio), and lateral patellar displacement using standardized skyline and lateral knee views. Pain severity was measured using the Numeric Pain Rating Scale (NPRS). Statistical analysis included independent t-tests, chi-square tests, and Pearson's correlation.
Results: Participants with knee pain exhibited significantly higher prevalence of patellofemoral malalignment features, including patella alta (p = 0.002), increased lateral patellar tilt (p < 0.001), increased congruence angle (p = 0.001), and abnormal sulcus angle (p = 0.003), compared to controls. No statistically significant difference was found in mean Q angle between groups (p = 0.078), although weak correlations were observed between Q angle and certain malalignment parameters. Pain severity was moderately correlated with lateral patellar tilt (r = 0.41, p < 0.01) and congruence angle (r = 0.38, p < 0.01).
Conclusion: Patellofemoral malalignment parameters are more commonly observed in individuals with knee pain than in asymptomatic controls, supporting their relevance in clinical assessment. Q angle alone may not be a reliable predictor of knee pain, but it can reflect underlying biomechanical alterations when interpreted alongside radiographic markers. Routine assessment of patellofemoral alignment may aid in early diagnosis and individualized management of anterior knee pain.
Keywords: Knee pain, patellofemoral malalignment, Q angle, congruence angle, patellar tilt, radiographic assessment, anterior knee pain
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