Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

Background: Patellofemoral pain (PFP) is a prevalent disorder among female adolescents. Overuse is frequently cited as the cause of pain for this population. What is currently unclear, however, is if the patella demonstrates abnormal tracking patterns relative to the femoral trochlear groove in female adolescents with PFP. Purpose: The aim of this case-control study was to determine if abnormal patellar tracking patterns are present in female adolescents with PFP. The secondary aim was to identify if an increased tibial tuberosity–trochlear groove (TT-TG) distance is associated with the observed kinematic patterns. Study Design: Controlled laboratory study. Methods: Twenty female adolescent knees from 12 patients with PFP and 20 age-matched female knees from 13 healthy controls were recruited for this study. Patellofemoral kinematics (eg, lateral patellar displacement) during a repetitive knee extension-flexion maneuver was quantified by dynamic cine phase-contrast magnetic resonance imaging (MRI). Static MRI scans were used to determine the TT-TG distance. Results: Relative to the control cohort, female adolescents with PFP demonstrated significantly greater lateral displacement at 10° (3.2 mm; P < .001), 20° (2.3 mm; P < .001), and 30° (1.7 mm; P = .014) of knee flexion. A subgroup within this cohort (7 knees from 5 patients) demonstrated extreme lateral maltracking >2 SDs of the mean of the control cohort. This subgroup also demonstrated a greater TT-TG distance relative to the controls (Δ = 4.2 mm; P = .001). Conclusion: This study demonstrates abnormal lateral patellar displacement in the absence of patellar tilt in female adolescents with PFP. Because all adolescents from both cohorts participated in impact sports, it appears that rigorous athletic training alone is inadequate to produce symptoms in this population. Rather, PFP may derive from a combination of physical activity in the context of pathological kinematics. Clinical Relevance: Abnormal patellar tracking patterns and abnormal static alignment have been shown to contribute to the etiology of patellofemoral pain in adults. This study demonstrates that pathologic patellar tracking patterns are present in adolescent females with patellofemoral pain.

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Geometry of Torsional Malalignment Syndrom: Trochlear Dysplasia but not Torsion Predicts Lateral Patellar Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00222 ◽

2019 ◽

Vol 7 (6_suppl4) ◽

pp. 2325967119S0022

Author(s):

Peter Balcarek ◽

Dennis Vogel

Keyword(s):

Inclination Angle ◽

Patellar Instability ◽

Trochlear Dysplasia ◽

Patellofemoral Pain ◽

Tibial Tuberosity ◽

Patellar Tracking ◽

Trochlear Groove ◽

Type B ◽

Tibial Torsion ◽

Torsional Malalignment

Aims and Objectives: To analyze parameters of limb malalignment and patellar tracking in patients with torsional malalignment syndrome presenting with clinical symptoms of either patellofemoral pain or patellar instability. Materials and Methods: Between April 2015 and July 2017, 428 patients were treated for lateral patellar instability (LPD), and 333 patients were treated for patellofemoral pain syndrome (PFPS). Sixty-two patients (14.5%) with patellar instability (LPD group) and 29 patients (8.7%) with patellofemoral pain (PFPS group) had additional torsional malalignment and were included in this study. All patients underwent magnetic resonance imaging assessment of torsional alignment and patellar tracking, including femoral antetorsion, tibial torsion, knee rotation, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, Dejour’s classification of trochlear dysplasia, lateral trochlear inclination angle, and patellar height Results: Groups differed significantly in terms of trochlear dysplasia (p<0.001), lateral trochlear inclination angle (p<0.001) and tibial tuberosity-trochlear groove distance (p=0.0167) but did not differ in terms of femoral torsion (LPD group 20.02° +/- 8.8°; PFPS group 20.03° +/- 7.91°; p=0.8545), tibial torsion (LPD group 39.53° +/- 9.23°; PFPS group 41.24° +/- 7.28°; p=0.3616), and knee rotation (LPD group 10.42° +/- 5.16°; PFPS group 8.48° +/- 7.81°; p=0.0163). Only measures of coronal alignment were positively correlated. This was also true for the tibial tuberosity-trochlear groove distance and knee rotation but not for any other parameters of torsional limb alignment. Trochlear dysplasia (type B-D) was identified as the only significant predictor of patellar instability. Conclusion: Torsional malalignment syndrome, represented in this study by two clinical entities - PFPS and LPD - is not characterized by a typical constellation of different malalignment parameters. Between groups, parameters differed significantly only in terms of trochlear dysplasia and the tibial tuberosity-trochlear groove distance, with trochlear dysplasia (type B-D), but not torsion, identified as predictor of lateral patellar instability.

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Tibial Tuberosity-Trochlear Groove Distance and Patellar Tracking in Symptomatic and Asymptomatic knees in Patients with Unilateral Patellofemoral Instability

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2014.04.036 ◽

2014 ◽

Vol 30 (6) ◽

pp. e15 ◽

Cited By ~ 1

Author(s):

Ariel Williams ◽

John Elias ◽

Miho Tanaka ◽

Shadpour Demehri ◽

Gaurav Thawait ◽

...

Keyword(s):

Patellofemoral Instability ◽

Tibial Tuberosity ◽

Patellar Tracking ◽

Trochlear Groove

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The Relationship Between Tibial Tuberosity–Trochlear Groove Distance and Abnormal Patellar Tracking in Patients With Unilateral Patellar Instability

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2015.06.037 ◽

2016 ◽

Vol 32 (1) ◽

pp. 55-61 ◽

Cited By ~ 26

Author(s):

Ariel A. Williams ◽

John J. Elias ◽

Miho J. Tanaka ◽

Gaurav K. Thawait ◽

Shadpour Demehri ◽

...

Keyword(s):

Patellar Instability ◽

Tibial Tuberosity ◽

Patellar Tracking ◽

Trochlear Groove ◽

The Relationship

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Research Methods and Progress of Patellofemoral Joint Kinematics: A Review

Journal of Healthcare Engineering ◽

10.1155/2019/9159267 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 4

Author(s):

Zhenguo Yu ◽

Jie Yao ◽

Xingliang Wang ◽

Xing Xin ◽

Ke Zhang ◽

...

Keyword(s):

Knee Flexion ◽

Patellofemoral Joint ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Joint Kinematics ◽

High Morbidity ◽

Trochlear Groove ◽

And Shifts ◽

Patellofemoral Kinematics

Patellofemoral pain syndrome has a high morbidity, and its pathology is closely associated with patellofemoral joint kinematics. A series of in vivo and in vitro studies have been conducted to explore patellofemoral kinematics, and the findings are relevant to the diagnosis, classification, and management of patellofemoral diseases and even the whole knee joint. However, no definite conclusion on normal patellofemoral kinematics has been established. In this study, the measurement methodologies of patellofemoral kinematics (including data collection methods, loading conditions, and coordinate system) as well as their advantages and limitations were reviewed. Motion characteristics of the patella were analyzed. During knee flexion, the patellar flexion angle lagged by 30–40% compared to the tibiofemoral joint flexion. The patella tilts, rotates, and shifts medially in the initial stage of knee flexion and subsequently tilts, rotates, and shifts laterally. The finite patellar helical axis fluctuates near the femoral transepicondylar axis or posterior condylar axis. Moreover, factors affecting kinematics, such as morphology of the trochlear groove, soft tissue balance, and tibiofemoral motion, were analyzed. At the initial period of flexion, soft tissues play a vital role in adjusting patellar tracking, and during further flexion, the status of the patella is determined by the morphology of the trochlear groove and patellar facet. Our findings could increase our understanding of patellofemoral kinematics and can help to guide the operation plan for patients with patellofemoral pain syndrome.

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FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

Medicinos teorija ir praktika ◽

10.15591/mtp.2015.100 ◽

2015 ◽

Vol 21 (4.1) ◽

pp. 638-642

Author(s):

Andrius Brazaitis ◽

Algirdas Tamosiunas ◽

Janina Tutkuviene

Keyword(s):

Patellar Instability ◽

Weight Bearing ◽

Patellofemoral Pain ◽

Full Weight Bearing ◽

Trochlear Groove ◽

Patellar Tilt ◽

Full Extension ◽

Low Degrees ◽

Mri Study ◽

Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

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The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04454-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhe Li ◽

Guanzhi Liu ◽

Run Tian ◽

Ning Kong ◽

Yue Li ◽

...

Keyword(s):

Individual Differences ◽

Chinese Population ◽

Pearson Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Tibial Tuberosity ◽

Trochlear Groove ◽

Lasso Regression ◽

Cross Sectional ◽

Anterior Posterior

Abstract Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately.

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Change of tibial tuberosity-trochlear groove (TT-TG) distance during total knee arthroplasty had no influence on clinical outcome and anterior knee pain

International Orthopaedics ◽

10.1007/s00264-021-05074-6 ◽

2021 ◽

Author(s):

Silvan Hess ◽

Timo Fromm ◽

Filippo Schiapparelli ◽

Lukas B. Moser ◽

Emma Robertson ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcome ◽

Knee Arthroplasty ◽

T Test ◽

Tibial Tuberosity ◽

Trochlear Groove ◽

Femoral Mechanical Angle ◽

Tibial Mechanical Angle ◽

Total Knee

Abstract Purpose The main purpose of this study was to determine whether there is a correlation between the change of tibial tuberosity-trochlear groove (TT-TG) distance and clinical outcomes after total knee arthroplasty (TKA). Methods A total of 52 knees undergoing TKA due to primary osteoarthritis were included in this retrospective study. All patients had pre- and postoperative CT scans. TT-TG distance was measured by two independent observers and the following alignment parameters were measured: hip-knee ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA), and posterior condylar angle (PCA). Clinical outcome was assessed using Knee Society Score (KSS) pre- and post-operatively and at a minimum of 12-month follow-up. Evidence of AKP was noted from follow-up reports. Pre- and postoperative scores were compared using a paired Student t-test. Pearson correlations were calculated to assess the influence of TT-TG on clinical outcome and of alignment parameters on the change in TT-TG. TT-TG between patients with and without AKP was compared using unpaired Student’s t-test (p < 0.05). Results Neither the absolute postoperative TT-TG nor the amount of change in TT-TG correlated with the post-operative KSS or the change in KSS. Post-operative TT-TG and change in TT-TG did not differ significantly between patients with and patients without AKP. Only the change in FMA showed a correlation with the change in TT-TG (p = 0.01, r = 0.36). Conclusion Despite a missing correlation between outcomes and TT-TG distance in this study, excessive TT-TG distance should be avoided. Furthermore, surgeons need to be aware that changes in femoral joint line orientation might affect TT-TG distance.

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