Which combination of factors would MOST likely predispose an athlete to patellofemoral pain?

• A. Femoral retroversion, tight hamstrings, & genu varum
• B. Tight quadriceps, coxa vara, & Q-angle less than 15º
• C. Weak quadriceps, pes cavus, & tight iliopsoas
• D. Weak quadriceps, genu valgum, & Q-angle greater than 18º

Answer: (D)

Patellofemoral pain often comes from the patella not tracking properly in the femoral groove, which is helped by strong, balanced thigh muscles and a knee alignment that keeps the patella moving smoothly. When the quadriceps are weak, especially the portion that helps pull the patella medially, there isn’t enough stability during bend-and-straighten movements. This lets the patella drift laterally more easily.

Genu valgum, or knock-knee alignment, increases the Q-angle—the angle between the line from the hip to the knee and the line from the knee to the shin. A larger Q-angle means a greater lateral pull on the patella as the knee flexes, which heightens lateral patellofemoral joint stress and makes maltracking more likely.

A Q-angle greater than about 18 degrees signals a substantial lateral force on the patella, amplifying the risk of pain from repetitive knee bending or jumping activities.

So, having weak quadriceps together with genu valgum and a large Q-angle creates both reduced medial stabilization and increased lateral force on the patella, making patellofemoral pain more likely than the other combinations.