Test-Retests Reliability of Digital Photography in Measuring Quadriceps-Angle and Pelvic Tilt Angle in Healthy Population

Aim: Capturing body images through digital photography method for calculation of quadriceps angles and pelvic position in clinical assessment is an inexpensive method. The aim of this study is to evaluate the reliability of measuring Q-angle and pelvic tilt angle with digital camera and Microdicom software. Place and duration: University of Lahore and Tehran University of medical sciences, from June 2020 to June 2021 Methods: Bilateral lower limbs of fifteen healthy asymptomatic subjects were considered for calculations of desired angles. A 13-megapixel camera was used to capture images of quadriceps angle (q-angle) measurement in an anterior view and for pelvic angle measurement image in lateral view along with specific landmark markers on the body were captured. Images were transferred to Microdicom software for calculating desire angles. Three trails of procedures and Intra-class Correlation Coefficient (ICC) with 95% Confidence Interval (CI), Munro’s classification for reliability coefficients were used for the description of degrees. Standard error of measurement (SEM) was also calculated. Results: The Intra-class correlation coefficient values for right side Q- angle was 0.949(0.878-.981) and for left side it was 0.924(0.819-0.972) and <0.005 significant p-value. The ICC results for measuring pelvic title angle in the right side .990 (.975-.996) and left legs were .991 (.974-.997). Showing that the results were highly reliable and significant (p<0.005). Conclusions: The q-angle and pelvic angle measured with digital image have excellent consistency and reliability. Keywords: angle, asymptomatic, Images, pelvic, quadriceps

HUBUNGAN Q-ANGLE DENGAN KESEIMBANGAN DINAMIS PADA LANJUT USIA DENGAN DIAGNOSIS OSTEOARTRITIS LUTUT DI PUSKESMAS TEGALLALANG I

Latar Belakang: Osteoartritis lutut merupakan proses degeneratif pada lanjut usia 60 tahun ke atas. Keluhan utama adalah nyeri lutut, kekakuan, keterbatasan gerak sendi, penurunan fleksibilitas dan kekuatan otot, hingga menyebabkan abnormalitas alignmen lutut. Terjadinya abnormalitas alignmen menyebabkan distribusi tekanan yang lebih tinggi pada sendi sehingga akan mengakibatkan ketidakstabilan pada patella akibatnya terjadi kelemahan pada otot quadriceps femoris yang mengakibatkan terjadi penurunan kemampuan mempertahankan keseimbangan dinamis. Tujuan: Tujuan penelitian ini untuk mengetahui hubungan antara Q-angle dengan keseimbangan dinamis pada lanjut usia dengan diagnosis osteoartritis lutut di Puskesmas Tegallalang I. Metode: Penelitian ini menggunakan metode studi potong lintang yang dilakukan pada 15 Maret sampai 9 April 2021 dengan populasi lanjut usia yang di diagnosis osteoartritis lutut yang telah memenuhi kriteria inklusi dan kriteria eksklusi. Responden dipilih dengan menggunakan teknik non probability sampling dengan bentuk purposive sampling, berdasarkan rumus besar sampel didapatkan 38 responden. Pengukuran Q-angle dengan menggunakan goniometer dan keseimbangan dinamis menggunakan time up and go test. Hasil: Hasil penelitian menunjukan analisis hubungan antara Q-angle dengan keseimbangan dinamis pada lanjut usia dengan diagnosis osteoartritis lutut dengan uji pearson dengan hasil p sebesar 0,003 (p<0,05) dengan nilai koefisien korelasi sebesar 0,476 (r>0,05) yang menunjukkan hubungan yang kuat. Simpulan: Terdapat hubungan antara Q-angle dengan keseimbangan dinamis pada lanjut usia dengan diagnosis osteoartritis lutut.

Patellofemoral Instability

Recurrent patellofemoral instability is a common cause of knee pain and functional disability in adolescent and young adult patients, resulting in loss of time from work and sports. There are numerous factors that contribute to recurrent patellofemoral instability; these factors include tear of the medial patellofemoral ligament (MPFL), weakening or hypoplasia of the vastus medialis obliquus (VMO), trochlear dysplasia, increased tibial tuberosity-trochlear groove (TT-TG) distance (>20 mm), valgus malalignment, increased Q angle, malrotation secondary to internal femoral or external tibial torsion, patella alta, and generalized ligamentous laxity. A detailed history and a thorough physical examination are crucial to clinch an early, accurate diagnosis. Imaging studies play an important role to confirm the clinical diagnosis and also help to identify concomitant intra-articular pathologies. Initially, nonoperative management (including the use of physical therapy, patellar taping or brace) is offered to patients with acute, first-time patellar dislocations and most patients respond well to this mode of treatment. Surgical treatment is indicated for patients who have post-trauma osteochondral fracture or loose body; predisposing anatomical risk factors; recurrent, symptomatic instability; and who have failed an adequate trial of nonoperative management. Surgical treatments include MPFL reconstruction, proximal or distal realignment procedures, and trochleoplasty. Lateral release is often performed in combination with other procedures and seldom performed as an isolated procedure. An individualized case-by-case approach is recommended based on the underlying anatomical risk factors and radiographic abnormality.

Influence of Overweight and Obesity on Pelvic Tilt, Q-Angle and Foot Posture in Both Genders

Background: Normal movement pattern and its relationship with various segments of the body create a kinetic chain for performing certain activities. The abnormal patterns of movement may precipitate risk of injuries at any segmentleg from the pelvis to the foot [1-3]. Obesity has been marked as risk factor for postural instability. The mechanism of altering body geometry due to excessive deposition of body fat at certain areas like abdomen and hips increases the stress on the musculoskeletal system leading to postural-instability. Aim: In study the effects of obesity on different segments of lower limb are being focused. Place & Duration: Data was collected in Pakistan. Study duration April 2020 to April 2021 Methods: After ethical approval, Consent and explanation of procedure the population was subdivided into three groups on the bases of BMI, with 50 samples in each group. For Pelvic tilt and Q-angle measurement the image captured with 13-megapixel camera and angle was measured[4]in computer with the help of Microdicom software. To evaluate foot posture, the foot posture index tool was used. The ICC95% calculated for validity and reliability of photography. Results: Validity and reliability test ICC 95% confidence interval for pelvic tilt and Q-angle measurement with photography method was 0.991 (0.974-.997) and 0.949(0.878-.981), with P-value 0.0001. There is significant different in pelvic tilt, Q-angle and foot posture of subjects with normal, overweight and obesity. Conclusion: Obesity has significant effect on Q-angle and pelvic tilt and foot posture. Key words: Q-angle, Posture, Pelvic, Obesity, Influence.

REVIEW: PATELLOFEMORAL PAIN SYNDROME

Patellofemoral pain syndrome is a common musculoskeletal condition and a major cause for anterior knee pain. It has been associated with excessive compression between the patella and the lateral femoral condyle. It is one of those overuse disorder that can limit activity of daily living along with participation in sports. The prevalence is more on female than those of male with the ratio of 2:1 and it affect athletic female more solely due to greater internal rotation of femur during running which leads to greater hip adduction. The reason for patellofemoral pain syndrome have been multifactorial increased femoral internal rotation, decreased hip abduction and external rotation strength, decreased VMO function and lateral retinaculum tightness. These factor leads to increase in dynamic Q angle that directly increases patellofemoral contact pressure which map a way to patellofemoral pain syndrome. The literature will have an explanation about altered hip kinetics, kinematics and its association with patellofemoral pain syndrome along with rehab protocol for patients with the same condition.

Kinect Azure–Based Accurate Measurement of Dynamic Valgus Position of the Knee—A Corrigible Predisposing Factor of Osteoarthritis

(1) Dynamic knee valgus is a predisposing factor for anterior cruciate ligament rupture and osteoarthritis. The single-leg squat (SLS) test is a widely used movement pattern test in clinical practice that helps to assess the risk of lower-limb injury. We aimed to quantify the SLS test using a marker-less optical system. (2) Kinect validity and accuracy during SLS were established by marker-based OptiTrack and MVN Xsens motion capture systems. Then, 22 individuals with moderate knee symptoms during sports activities (Tegner > 4, Lysholm > 60) performed SLS, and this was recorded and analyzed with a Kinect Azure camera and the Dynaknee software. (3) An optical sensor coupled to an artificial-intelligence-based joint recognition algorithm gave a comparable result to traditional marker-based motion capture devices. The dynamic valgus sign quantified by the Q-angle at the lowest point of the squat is highly dependent on squat depth, which severely limits its comparability among subjects. In contrast, the medio-lateral shift of the knee midpoint at a fixed squat depth, expressed in the percentage of lower limb length, is more suitable to quantify dynamic valgus and compare values among individual patients. (4) The current study identified a new and reliable way of evaluating dynamic valgus of the knee joint by measuring the medial shift of the knee-over-foot at a standardized squat depth. Using a marker-less optical system widens the possibilities of evaluating lower limb functional instabilities for medical professionals.