Discussion

The present study was done to evaluate gender-based bilateral differences in the Q-angle and ICD in an adult North Indian population. The findings of this study show that the Q-angle is statistically significant between male participants and female participants, with female participants demonstrating higher Q-angle values (16.53 ± 5.22°) compared to male participants (13.85 ± 5.32°). The ICD in male participants is 9.39 ± 1.33 cm and in female participants, it is 9.26 ± 1.36 cm. Though male participants exhibited slightly higher values than female participants, the difference between the two genders was not statistically significant.

A key finding of this study was the significantly higher Q-angle observed in female participants compared to male participants. This observation is consistent with previous studies, which have attributed this difference primarily to anatomical and biomechanical factors such as increased pelvic width, greater femoral anteversion, and lateral positioning of the tibial tuberosity in women [15,16]. Shantanu et al. reported that women consistently exhibit higher Q-angle values than men, which may increase the chance of developing patellofemoral disorders [15]. Similarly, Verma et al. found statistically significant gender differences, emphasizing the role of anatomical alignment in influencing Q-angle [16]. An increased Q-angle has been associated with lateral patellar tracking, patellofemoral pain syndrome, and a higher risk of ACL injuries [17,18]. These findings support biomechanical theory that altered alignment in females increases stress across the patellofemoral joint. Bhaskaran et al. (2016) further demonstrated that variations in Q-angle influence patellar stability and joint loading patterns [17].

In the present study, bilateral comparison revealed minimal differences between the right and left sides in both the Q-angle and ICD; however, the difference observed in the Q-angle was statistically significant. These findings were consistent with a study done by Kumar et al. (2023), suggesting that while bilateral asymmetry may exist, it is often small and may not be clinically significant and that slight differences between limbs may arise due to limb dominance or habitual activity patterns rather than pathological conditions [13].

ICD, on the other hand, did not show significant variation between males and females in this study. This suggests that ICD, as a linear measurement, may be less influenced by gender related anatomical differences compared to angular measurements like Q-angle. Similar findings have been reported in previous studies conducted by Omololu et al. (2003), where ICD remained relatively stable across different populations [19]. In contrast to the present study, Chauhan et al. (2017) performed a study on condylar distance on 100 dry femora. The condylar width of the femur was 73.11±6.14 mm on the right side and 72.16±6.58 mm on the left side. The study found that the condylar distance on the right limb was more often greater than that on the left side. Similarly, Kumar et al. (2023) show a positive correlation between the Q-angle and ICD in the 500-adult population (p-value = 0.0001) [13].

The lack of significant correlation between Q-angle and ICD suggests that these parameters should be assessed independently during clinical evaluation. A single parameter may not provide a complete understanding of knee alignment and biomechanics. This study also provides valuable normative data for the Indian population, which is essential for clinical and ergonomic assessment. Overall, the present study strengthens the importance of considering gender differences and bilateral assessment in the evaluation of lower limb biomechanics. The findings provide a foundation for future research and clinical applications aimed at improving knee health and preventing injuries.

Limitations

The cross-sectional design confines the ability to establish causal relationships. The measurements were taken in a static position, which may not fully reflect dynamic knee biomechanics during functional activities. Additionally, factors such as physical activity level, muscle strength, and limb dominance were not extensively analyzed.