Background and Objectives: Patellofemoral Pain Syndrome (PFPS) is a highly preva-lent knee injury in sports. Despite its mechanical plausibility, the clinical utility of the quadriceps angle (Q-angle) as a risk predictor remains controversial. This study aims to analyze the association between the Q-angle and PFPS in university athletes, evalu-ating the variable based on its parameters of morphological normality according to bi-ological sex. Methods: An analytical observational cross-sectional study was conduct-ed with 112 university athletes. The presence of PFPS was determined using the Kujala Scale. Anthropometric variables, body composition, and Q-angle goniometry were measured. The Q-angle was analyzed both as a continuous quantitative variable and as a dichotomized categorical variable (Normal vs. Altered), based on sex-specific physiological limits (10°–15° for men; 15°–20° for women). Bivariate analyses were performed using Chi-square, Student’s t, and Mann-Whitney U tests. Results: The prevalence of PFPS was 30.3% (n=34). No significant differences were found between groups regarding sex, sports discipline, or body composition (p > 0.05). When evaluat-ing the Q-angle as a continuous variable, absolute means did not differ significantly between asymptomatic and affected individuals (p > 0.05). However, the clinical cate-gorization demonstrated a highly significant association: an altered Q-angle was strongly associated with the presence of PFPS in both the right and left knees (p = 0.001). Conclusions: Clinical alteration of the Q-angle, rather than its absolute contin-uous value or the athlete's general body phenotype, is directly associated with PFPS. Stratified categorical goniometry remains a highly effective tool for preventive screening in university athletes.