The Effect of a Tibial-Tubercle Transplant in Children on the Growth of the Upper Tibial Epiphysis

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

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Comparing the Tibial Tuberosity–Trochlear Groove Distance Between CT and MRI in Skeletally Immature Patients With and Without Patellar Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120973665 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097366

Author(s):

Zhen-Zhen Dai ◽

Lin Sha ◽

Zi-Ming Zhang ◽

Zhen-Peng Liang ◽

Hao Li ◽

...

Keyword(s):

Patellar Instability ◽

Intraclass Correlation ◽

Mean Difference ◽

Tibial Tubercle ◽

Control Group ◽

Trochlear Groove ◽

Skeletally Immature ◽

Bony Landmarks ◽

The Difference ◽

Ct And Mri

Background: The tibial tubercle–trochlear groove (TT-TG) distance was originally described for computed tomography (CT), but it has been measured on magnetic resonance imaging (MRI) in patients with patellar instability (PI). Whether the TT-TG measured on CT versus MRI can be considered equivalent in skeletally immature children remains unclear. Purpose: To investigate in skeletally immature patients (1) the effects of CT versus MRI imaging modality and cartilage versus bony landmarks on consistency of TT-TG measurement, (2) the difference between CT and MRI measurements of the TT-TG, and (3) the difference in TT-TG between patients with and without PI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively identified 24 skeletally immature patients with PI and 24 patients with other knee disorders or injury but without PI. The bony and cartilaginous TT-TG distances on CT and MRI were measured by 2 researchers, and related clinical data were collected. The interrater, interperiod (bony vs cartilaginous), and intermethod (CT vs MRI) reliabilities of TT-TG measurement were assessed with intraclass correlation coefficients. Results: The 48 study patients (19 boys, 29 girls) had a mean age of 11.3 years (range, 7-14 years). TT-TG measurements had excellent interrater reliability and good or excellent interperiod reliability but fair or poor intermethod reliability. TT-TG distance was greater on CT versus MRI (mean difference, 4.07 mm; 95% CI, 2.6-5.5 mm), and cartilaginous distance was greater than bony distance (mean difference, 2.3 mm; 95% CI, 0.79-3.8 mm). The TT-TG measured on CT was found to increase with the femoral width. Patients in the PI group had increased TT-TG distance compared with those in the control group, regardless of landmarks or modality used ( P > .05 for all). Conclusion: For skeletally immature patients, the TT-TG distance could be evaluated on MRI, regardless of whether cartilage or bony landmarks were used. Its value could not be interchanged with CT according to our results; however, further research on this topic is needed.

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Return to Work and Sport Following Tibial Tubercle Anteromedialization

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2020.12.152 ◽

2021 ◽

Vol 37 (1) ◽

pp. e74

Author(s):

Matthew Kingery ◽

David A. Bloom ◽

Alexander Hoberman ◽

Brian Fliegel ◽

Michael J. Alaia ◽

...

Keyword(s):

Return To Work ◽

Tibial Tubercle

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Distalising tibial tubercle osteotomy decreases patellar tendon force — A treatment rationale for recalcitrant patellar tendinopathy

The Knee ◽

10.1016/j.knee.2020.02.022 ◽

2020 ◽

Vol 27 (3) ◽

pp. 871-877 ◽

Cited By ~ 1

Author(s):

Michael J. Dan ◽

Joseph Cadman ◽

James McMahon ◽

William C.H. Parr ◽

David Broe ◽

...

Keyword(s):

Patellar Tendon ◽

Patellar Tendinopathy ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

Tendon Force

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Chronic Riboflavin Deficiency in the Rat. I. Ossification in the Proximal Tibial Epiphysis.

Experimental Biology and Medicine ◽

10.3181/00379727-66-16178 ◽

1947 ◽

Vol 66 (3) ◽

pp. 631-635 ◽

Cited By ~ 8

Author(s):

M. M. Nelson ◽

E. Sulon ◽

H. Becks ◽

H. M. Evans

Keyword(s):

Riboflavin Deficiency ◽

Tibial Epiphysis

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SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00132 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0013

Author(s):

Alexandra H. Aitchison ◽

Kenneth M. Lin ◽

Daniel W. Green

Keyword(s):

Patellar Instability ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Extensor Mechanism ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Medial Patellofemoral Ligament Reconstruction ◽

Force Vector ◽

Tibiofemoral Rotation ◽

The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

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