Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic 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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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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End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-012-2357-z ◽

2012 ◽

Vol 22 (1) ◽

pp. 214-218 ◽

Cited By ~ 50

Author(s):

Tobias J. Dietrich ◽

Michael Betz ◽

Christian W. A. Pfirrmann ◽

Peter P. Koch ◽

Sandro F. Fucentese

Keyword(s):

Tibial Tuberosity ◽

Trochlear Groove ◽

Asymptomatic Volunteers ◽

End Stage

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The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning

The Knee ◽

10.1016/j.knee.2005.06.003 ◽

2006 ◽

Vol 13 (1) ◽

pp. 26-31 ◽

Cited By ~ 302

Author(s):

Philip B. Schoettle ◽

Marco Zanetti ◽

Burkart Seifert ◽

Christian W.A. Pfirrmann ◽

Sandro F. Fucentese ◽

...

Keyword(s):

Comparative Study ◽

Tibial Tuberosity ◽

Trochlear Groove ◽

Ct And Mri

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Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-Trochlear Groove Distance

10.21203/rs.3.rs-291693/v1 ◽

2021 ◽

Author(s):

Conglei Dong ◽

Chao Zhao ◽

Ming Li ◽

Huijun Kang ◽

Kang Piao ◽

...

Keyword(s):

Patellofemoral Joint ◽

Tibial Tuberosity ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Patellofemoral Arthritis ◽

Patellofemoral Arthroplasty ◽

Group I ◽

Tibial Tubercle Transfer ◽

Group Ii

Abstract BackgroundThe objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm). MethodsA prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05) ResultsPreoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups. ConclusionsFor such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

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