Excessive Q-Angle and its association with sports injury risk: A literature review
Keywords:
Q-angle, quadriceps angle, knee biomechanics, sports injury, injury riskAbstract
Background: The quadriceps angle (Q-angle) is an anatomical parameter reflecting lower extremity alignment and knee biomechanics. Abnormal or excessive Q-angle has been proposed as an intrinsic risk factor for sports-related injuries, particularly involving the knee joint. Objective: This review aimed to summarize current evidence regarding the association between Q-angle and the risk of sports-related injuries in athletes and physically active individuals. Methods: A narrative literature review was conducted using PubMed and Google Scholar databases. Articles published between 2020 and 2025 were identified using relevant keywords related to Q-angle, injury risk, and sport. Original research and review articles involving human participants were included and analyzed descriptively. Results: Most studies reported that increased and abnormal Q-angle values are associated with altered lower extremity alignment, increased patellofemoral stress, impaired patellar tracking, and a greater tendency toward dynamic knee valgus. These biomechanical alterations were linked to a higher risk of patellofemoral pain syndrome, iliotibial band syndrome, patellar instability, and knee ligament injuries. Higher and asymmetric Q-angle values were more frequently observed in female athletes and in sports involving repetitive and high-impact movements. Conclusion: Excessive Q-angle appears to be an important anatomical factor associated with increased lower extremity injury risk.
Downloads
References
Aderem, J., & Louw, Q. A. (2015). Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC musculoskeletal disorders, 16(1), 356.
Almeida, G. P. L., Carvalho, A. P. D. M. C., França, F. J. R., Magalhães, M. O., Burke, T. N., & Marques, A. P. (2016). Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Revista Brasileira de Ortopedia (English Edition), 51(2), 181-186. https://doi.org/10.1016/j.rboe.2016.01.010
Araújo, V. L., Souza, T. R., do Carmo Carvalhais, V. O., Cruz, A. C., & Fonseca, S. T. (2017). Effects of hip and trunk muscle strengthening on hip function and lower limb kinematics during step-down task. Clinical biomechanics, 44, 28-35. https://doi.org/10.1016/j.clinbiomech.2017.02.012
Chaturvedi, P., & Khanvilkar, N. (2025). The impact of Q-angle variations on knee biomechanics and injury risk in youth football players. International Scientific Journal of Engineering and Management (ISJEM), 4(5).
Choudhary, R., Malik, M., Aslam, A., Khurana, D., & Chauhan, S. (2019). Effect of various parameters on Quadriceps angle in adult Indian population. Journal of clinical orthopaedics and trauma, 10(1), 149-154. https://doi.org/10.1016/j.jcot.2017.11.011
Freedman, B. R., Brindle, T. J., & Sheehan, F. T. (2014). Re-evaluating the functional implications of the Q-angle and its relationship to in-vivo patellofemoral kinematics. Clinical biomechanics, 29(10), 1139-1145. https://doi.org/10.1016/j.clinbiomech.2014.09.012
Gant, H., Ghimire, N., Min, K., Musa, I., Ashraf, M., & Lawan, A. (2024). Impact of the quadriceps angle on health and injury risk in female athletes. International Journal of Environmental Research and Public Health, 21(12), 1547.
Gonzalez, R., & Ramirez, J. (2021). Influence of Q-angle variations on patellar tracking in youth football players. Orthopedic Research Journal, 38(5), 455–467.
Gülf?rat, Ö., Ekinci, M., Kumak, A., & Tazegül, Ü. (2025). Evaluation of the relationship between the bone alignment of the lower extremity and the importance of Q angle in male athletes. Science Progress, 108(1), 00368504241304202.
Hikawa, K., Shimizu, R., & Takahashi, S. (2025). Features of Elite Athletes' High and Asymmetric Quadriceps Angles: A Cross?Sectional Study. Health Science Reports, 8(6), e70909.
Jafari, A. A., Lotfi-Kamran, M. H., Ghafoorzadeh, M., & Shaddel, S. M. (2017). Quadriceps angle and risk of lower extremity injuries in runners. Journal of Orthopaedic & Sports Physical Therapy, 37(12), 725–733.
Kumarantini, N. W. P., Putra, I. P. Y. P., Winaya, I. M. N., & Artini, I. G. A. (2025). The Role of Q-Angle in the Risk of Iliotibial Band Syndrome Among Runners in Denpasar: A Cross-Sectional Study. Majalah Ilmiah Fisioterapi Indonesia, 13(2), 248-255.
Mancino, F., Gabr, A., Plastow, R., & Haddad, F. S. (2023). Anterior cruciate ligament injuries in female athletes: is it time for a new approach?. The Bone & Joint Journal, 105(10), 1033-1037.
McKay, J., Maffulli, N., Aicale, R., & Taunton, J. (2020). Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study. Journal of orthopaedic surgery and research, 15(1), 188.
Phatama, K. Y., Isma, S. P. P., Devi, L. K., Siahaan, L. D., Pribadi, A., Pradana, A. S., ... & Hidayat, M. (2022). Relationship of anterior knee pain with quadriceps angle and anthropometric measurements in an Asian female population. Malaysian Orthopaedic Journal, 16(2), 95-101.
Rais, G. (2022). Hubungan bentuk dan panjang kaki terhadap terjadinya iliotibial band syndrome (ITBS) pada runners. Journal of Health Studies, 6(1), 45–52.
Rashmika, L. W., & Weerarathna, L. R. N. D. (2023). Relationship between quadriceps angle, body parameters, and occurrence of lower extremity injuries of Sri Lankan national level athletes. IOSR Journal of Sports and Physical Education, 10(1), 58–64.
Rauh, M. J., Koepsell, T. D., Rivara, F. P., Rice, S. G., & Margherita, A. J. (2007). Quadriceps angle and risk of injury among high school cross-country runners. Journal of Orthopaedic & Sports Physical Therapy, 37(12), 725-733.
Saber, B., Bridger, D., & Agrawal, D. K. (2024). A Critical Analysis of the Factors Contributing to Anterior Cruciate Ligament Injuries in Female Athletes. Journal of orthopaedics and sports medicine, 6(4), 203-209.
Sharma, R., Vaibhav, V., Meshram, R., Singh, B., & Khorwal, G. (2023). A systematic review on quadriceps angle in relation to knee abnormalities. Cureus, 15(1).
Van Gent, R. N., Siem, D., Van Middelkoop, M., Van Os, A. G., Bierma-Zeinstra, S. M. A., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine, 41(8), 469-480.
Wido, A., Bajamal, A. H., Apriawan, T., Parenrengi, M. A., & Al Fauzi, A. (2022). Deep vein thrombosis prophylaxis use in traumatic brain injury patients in tropical climate. International Journal of Health & Medical Sciences, 5(1), 67-74. https://doi.org/10.21744/ijhms.v5n1.1840
Published
How to Cite
Issue
Section
Copyright (c) 2026 International journal of health & medical sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health & Medical Sciences (IJHMS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHMS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHMS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.


