Tibial Tuberosity–Trochlear Groove Distance in Chinese Patients with or without Recurrent Patellar Dislocation

Background: Closing-wedge distal femoral osteotomy (CWDFO)—combined with medial reefing and lateral release, if necessary— has been used to treat recurrent patellar dislocation (RPD) with genu valgum. Purpose: To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum. Study Design: Case series; Level of evidence, 4. Methods: Fourteen consecutive patients (23 knees) with RPD and genu valgum were treated with CWDFO. Patients with a minimum 2-year follow-up period were eligible for this study. Patients with prior failed surgery were also eligible. Radiographic evaluation was performed with mechanical femorotibial and lateral distal femoral angle. The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPD were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes (eg, occurrence of redislocation, range of motion, and clinical scores) were assessed pre- and postoperatively at a minimum of 2 years. Results: At a mean follow-up of 30.7 months (range, 25-62 months), the mean mechanical femorotibial and mechanical lateral distal femoral angles changed significantly from valgus 5° (range, 2°-11°) to varus 3° (2°-11°; P < .001) and from 83° (range, 78°-86°) to 89° (84°-92°; P < .001), respectively. The mean patellar congruence angle improved from 40° lateral (range, 20°-53° lateral) to 4° medial (23° medial to 21° lateral; P < .001), as did the lateral patellofemoral angle from 26° (range, 8°-62°) to 9° (0°-15°; P < .001). Computed tomography scans showed that the mean distance of patellar lateral shift decreased from 13.5 mm (range, 4-22 mm) to 2.0 mm (–4 to 5 mm; P < .001). The mean tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm ( P < .001), while the Caton-Deschamps ratio did not change significantly after surgery ( P = .984). Chondral lesions of the patella and trochlear groove significantly improved or were maintained. None of the patients experienced subluxation or redislocation after surgery. Patellar instability symptoms also improved, as validated by radiographic and other clinical outcomes. Conclusion: CWDFO combined with medial reefing and lateral release successfully treated RPD with genu valgum for a minimum follow-up of 2 years, with improved patellar alignment and stability.

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Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06581-0 ◽

2021 ◽

Author(s):

Marc-Daniel Ahrend ◽

Tobias Eisenmann ◽

Moritz Herbst ◽

Boyko Gueorguiev ◽

Gabriel Keller ◽

...

Keyword(s):

Patellar Dislocation ◽

Recurrent Dislocation ◽

Patellar Height ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Recurrent Patellar Dislocation ◽

Patellar Tilt ◽

Level Of Evidence ◽

Sulcus Angle ◽

Patellar Shift

Abstract Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

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What Components Comprise the Measurement of the Tibial Tuberosity-Trochlear Groove Distance in a Patellar Dislocation Population?

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.n.01313 ◽

2015 ◽

Vol 97 (17) ◽

pp. 1441-1448 ◽

Cited By ~ 28

Author(s):

Keiji Tensho ◽

Yusuke Akaoka ◽

Hiroki Shimodaira ◽

Seiji Takanashi ◽

Shota Ikegami ◽

...

Keyword(s):

Patellar Dislocation ◽

Tibial Tuberosity ◽

Trochlear Groove

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Tibial Tubercle to Trochlear Groove Distance and Index in Children with One-Time versus Recurrent Patellar Dislocation: A Magnetic Resonance Imaging Study

Journal of Orthopaedic Surgery ◽

10.1177/1602400226 ◽

2016 ◽

Vol 24 (2) ◽

pp. 253-257 ◽

Cited By ~ 5

Author(s):

Ching Sing Nicholas Yeoh ◽

Kai Yet Lam

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Patellar Dislocation ◽

Imaging Study ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Magnetic Resonance Imaging Study ◽

Resonance Imaging ◽

Recurrent Patellar Dislocation

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Evaluation of risk correlation between recurrence of patellar dislocation and damage to the medial patellofemoral ligament in different sites caused by primary patellar dislocation by MRI: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01984-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Boyong Jiang ◽

Chenggang Qiao ◽

Yuting Shi ◽

Yizhong Ren ◽

Changxu Han ◽

...

Keyword(s):

Surgical Treatment ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Meta Analysis ◽

Recurrent Dislocation ◽

Cochrane Library ◽

Trochlear Groove ◽

Recurrent Patellar Dislocation ◽

Sulcus Angle ◽

Dislocation Group

Abstract Purpose Non-surgical treatment of primary patellar dislocation has a high risk of recurrent dislocation; thus, we tried to identify injuries in which sites of the medial patellofemoral ligament (MPFL) were most associated with recurrent dislocation by analyzing relevant original literature in order to provide improved suggestions on early surgical treatment. Methods According to the preset retrieval strategy, the original studies were retrieved until January 2020 using MEDLINE, Embase and Cochrane Library. Review Manager 5.3 software was used to summarize and compare the differences of recurrent dislocation of MPFL injuries at different attachments. Results Although the incidence of recurrent patellar dislocation at the femoral attachment of MPFL was higher overall (femoral only vs. patellar only vs. combined: 37.6% vs. 32.3% vs. 35.8%), no statistical difference was found among the three groups (femoral only vs. patellar only, RR = 1.32 [95% CI 0.89–1.95]; P = 0.17) (femoral only vs. combined, RR = 1.15 [95% CI 0.59–2.22]; P = 0.68) (patellar only vs. combined, RR = 0.94 [95% CI 0.69–1.29]; P = 0.72). In addition, the sulcus angle of recurrent dislocation group is significantly greater than that in the non-recurrent dislocation group (MD = 3.06 [95% CI 0.42–5.70]; P = 0.02). Conclusions Based on the pooled data collected from the original studies available, the risk of recurrent patellar dislocation due to damage to the MPFL at different sites did not differ. Additionally, the sulcus angle in the group with recurrent dislocation was considerably higher when comparing with the group without recurrent dislocation, that is, the shallower and flatter of the trochlear groove, the higher the risk of recurrent patellar dislocation.

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Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2020-0005 ◽

2020 ◽

Vol 3 (1) ◽

pp. 20-28

Author(s):

Georgian Iacobescu ◽

Adrian Cursaru ◽

Dan Anghelescu ◽

Mihnea Popa ◽

Dan Popescu

Keyword(s):

Computed Tomography ◽

Patellar Dislocation ◽

Rotation Angle ◽

Tibial Tuberosity ◽

Tibial Tubercle ◽

Control Group ◽

Study Group ◽

Trochlear Groove ◽

Tibial Tubercle Osteotomy ◽

Lateral Patellar Dislocation

AbstractIntroduction: Lateral patellar dislocation (LPD) is a common injury of the knee, most frequent in young patients. It has a multifactorial etiology with several underlying risk factors. In most cases, patellar dislocation occurs on the lateral side, with the rupture of the medial patellofemoral ligament (MPFL), appearing in more than 80% of the cases. The tibial tuberosity-trochlear groove (TT-TG) distance of 20 mm or more in patients with lateral patellar dislocation is a gold standard for the surgical indication of tibial tubercle osteotomy (TTO).Hypothesis: Our investigation aimed to establish whether there is a correlation between the TT-TG distance and other bony landmarks, like trochlear groove medialization, tibial tuberosity lateralization, and knee rotation angle, in the surgical algorithm for the patient with patellar dislocation.Methods: We conducted a prospective study, analyzing and comparing data from two groups, 33 patients with a diagnosis of patellar dislocation, and a control group of 30 patients, with meniscal injury, but healthy contralateral limb. Using computed tomography, we measured the TT-TG distance, femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization of all the patients in our study. The measurements were conducted by two independent orthopedic surgeons in a randomized manner. Using an unpaired t test, we compared and analyzed each parameters value from the study and the control group.Results: Comparing the two groups, we observed a significant difference for TT-TG distance, knee rotation angle and tibial tuberosity lateralization with higher values in the study group compared to the control group (CI 95% 6.44-9.72, CI 95% 8.64-10.39, CI 95% 3.77-5.46, respectively), with a p value < 0.0001 in all cases. Also, the TT-TG distance positively correlated with knee rotation angle (r=.97, p=0.01) and tibial tuberosity lateralization (r=.86, p=0.0001) in the study group.Conclusions: The TT-TG distance measurement usually defines the lateralization of the tibial tuberosity; yet, in some cases, it can be caused by the trochlear groove medialization, or high rotation between the femur and tibia. Our study revealed that knee rotation and tuberosity lateralization were factors implicated in patellar dislocation and they should be taken into account when making the decision of tibial tubercle osteotomy.

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