From foot to knee

Increased pronation as a risk parameter for rupture of the anterior crusiate ligament. A quantitative, controlled, comparative analysis of two groups and a reliability study of a navicular drift test

By: Karsten Pagaard and Peter Jeppesen
Supervisors: Inge Birthe Bjørnlund, study coordinator at Copenhagen College of Physiotherapy, CVU Øresund
Henning Langberg, senior researcher at Institute of Sports Medicine - Copenhagen, Bispebjerg Hospital
Copenhagen

Contact: Peter Jeppesen

Background: ACL ruptures are a costly affair for society. The cost could perhaps be reduced through prevention. Literature elucidates that malalignment in UE may be a cause of ACL rupture.

Objective: To test the possible relationship between increased pronation, increased Q-angle, and ACL ruptures. Tests conducted from a spot check of “active, adult Danes between 18 and 50 years”. To investigate if Navicular drift is reliable.

Participants and method: A quantitative study of 55 ACL rupture persons and a control group of 85 healthy persons, using Feiss Line, Navicular drift, and Q-angle. Test of the intraday reliability of Navicular drift on 85 persons.

Results: The Feiss Line data of the ACL rupture persons compared with the data of the control persons yields a p-value < 0.0001. At Navicular drift, the p-value is 0.3331. A comparison between the Q-angle data of the ACL rupture persons and that of the control group yields a p-value of 0.0771.
The intrareliability of Navicular drift shows a Spearman correlation of r=0.95 for test person 1 and 0.90 for test person 2.
The interreliability of Navicular drift shows a Spearman correlation of r=0.81 for the first measurement and 0.84 for the second one.

Discussion: Has the palpation been conducted accurately? Has the test battery been too extensive? Are the two groups comparable?

Conclusion: We cannot definitively conclude that increased pronation is a risk parameter for ACL ruptures. Feiss Line shows a significant difference between the pronation in the two groups. Neither the Navicular drift test nor the Q-angle shows any significant differences between the pronation in the two groups. Navicular drift has a strong intraday intra- and interreliability.

Perspective: It is necessary to investigate whether Navicular drift is a valid test. A study must be made to investigate how high the degree of pronation has to be before it is clinically relevant. Studies must be made investigating if a static test for pronation is an expression of what happens in the foot during movement.

Keywords: Malalignment, Pronation, ACL rupture, Feiss Line, Q-angle