scholarly journals Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: A CT analysis

2020 ◽  
Author(s):  
Yufeng Lu ◽  
Xiaoyu Ren ◽  
Benyin Liu ◽  
Peng Xu ◽  
Yangquan Hao
Keyword(s):  
Patellar Tendon ◽  
External Rotation ◽  
Knee Joints ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Chinese Adults ◽  
Tibiofemoral Rotation ◽  
Anterior Tibial ◽  
Ct Analysis ◽  
The Mean

Abstract Background: Consensus on tibial rotation in total knee arthroplasty (TKA) remains controversial. The present study aimed to investigate the closest anatomical reference to surgical epicondylar axis (SEA) among 10 tibial markers in Chinese adults.Methods: This study included examination of 122 normal lower extremities. Briefly, 10 axes were drawn on the axial sections: transverse axis of tibia (TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1⁄3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle (MBTT), and axis of anterior border of the tibia 1-4 (ATC1-4). The mean angles between TAT and SEA and that between other axes and the line perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined by applying one-way analysis of variance (ANOVA) and paired t-test.Results: In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes were compared to the line perpendicular to the projected SEA and found to be 10.2 ± 5.1°, 1.4 ± 5.0°, 11.9 ± 5.4°, 3.6 ± 4.8°, 12.0 ± 6.9°, 7.2 ± 8.6°, 7.1 ± 10.4°, and 6.6 ± 13.5° external rotation, respectively, and the MEPT axis was 1.6 ± 4.5° internal rotation. The mean angle for TAT was 4.1 ± 5.3° external rotation. The M1⁄3 and Insall line were significantly more externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. No significant differences were noted between the TAT axis and the MBTT axis and among the ATC2, ATC3, and ATC4 axes.Conclusion: The Akagi line, MBTT, and TAT showed good consistency with SEA in the axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also demonstrated good alignment consistency with SEA for the axial femorotibial alignment. Hence, these markers can be used as reliable references for rotational alignment of the tibial component in TKA.

scholarly journals A CT study of tibiofemoral rotation alignment in normal knee joint of Chinese adult

2020 ◽  
Author(s):  
Yufeng Lu ◽  
Xiaoyu Ren ◽  
Benyin Liu ◽  
Peng Xu ◽  
Yangquan Hao
Keyword(s):  
Patellar Tendon ◽  
External Rotation ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Test Results ◽  
Chinese Adult ◽  
Tibiofemoral Rotation ◽  
Significant Difference ◽  
Anterior Tibial ◽  
Total Knee

Abstract Background : Tibial rotation in total knee arthroplasty remains controversial. The aim was to investigate which anatomical reference was closer to SEA in 10 tibial markers in Chinese adult. Methods : The study included 122 normal lower extremities. 10 axes were drawn on the axial sections: transverse axis of tibia(TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1⁄3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle(MBTT)，axis of anterior border of the tibia 1-4(ATC1-4). The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using one-way ANOVA and paired t-test. Results : In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes compared to perpendicular of projected SEA were 10.2±5.1°, 1.4±5.0°, 11.9±5.4°, 3.6±4.8°, 12.0±6.9°, 7.2±8.6°, 7.1±10.4°, and 6.6±13.5° external rotation, respectively, and the MEPT axis was 1.6±4.5° internal rotation. The TAT was 4.1±5.3° external rotation compared to SEA. The M1⁄3 and Insall line were significantly externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. There was no significant difference between the TAT axis and the MBTT axis, as well as no significant difference between the ATC2, ATC3, and ATC4 axes. Conclusion : Akagi line, MBTT and TAT show good consistency with SEA in axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also has good alignment consistency with SEA in axial femorotibial alignment, it can be reliable reference mark for rotational alignment of the tibial component in TKA.

scholarly journals INCREASED TIBIOFEMORAL ROTATION WITH INCREASING SEVERITY OF PATELLAR INSTABILITY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0023
Author(s):  
Kenneth M. Lin ◽  
Evan W. James ◽  
Lindsay Schlichte ◽  
Grace Wang ◽  
Daniel Green
Keyword(s):  
Patellar Instability ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Trochlear Groove ◽  
Clinical Effects ◽  
Tibiofemoral Rotation ◽  
The Relationship

Background: Tibiofemoral rotation (TFR), specifically external tibial rotation, has been recently identified as a potential contributing factor to patellar instability. However, no previous studies have explored the clinical effects of differing degrees of TFR in relation to patellar instability. Purpose and Hypothesis: The purpose of this study is to investigate the relationship between severity of instability with degree of TFR. Our hypothesis is that fixed or obligatory dislocators (FOD) are more likely to have increased external TFR (tibial external rotation compared to femur) than standard patellar instability (SPI) patients requiring medial patellofemoral ligament (MPFL) reconstruction, who will have similar or slightly increased external TFR compared to normal controls. Methods: A retrospective study was performed with patients from 3 cohorts from April 2009 to February 2019: FOD, SPI, and controls with normal magnetic resonance imaging (MRI) of the knee. All FOD patients from the study time frame were analyzed, while controls and SPI patients were randomly selected. Patients were included for age under 18 years and diagnosis corresponding to one of the three cohorts, and excluded for outside institution MRI, and previous MPFL reconstruction or tibial tubercle osteotomy. TFR was measured on preoperative axial MRI using the posterior femoral and tibial condylar lines (Figure 1). Tibial tubercle to trochlear groove distance (TT-TG) was measured. Intraclass correlation coefficient (ICC) was calculated among 3 measurers. Statistical analysis using ANOVA and t-test was performed with significance set at α=0.05. Results: A total of 57 patients were included, 19 in each cohort. Average age was 13.2 years (range 10-17 years), with 31 females (54%). ICC for TT-TG and TFR were 0.90 and 0.72, respectively. TT-TG differed between the controls and SPI patients (both P<0.001), and controls and FOD patients (P<0.001), but not between SPI and FOD patients (P=0.12). TFR differed among the three groups: 8.4° (SD 16.7°) external TFR in FOD, 1.6° (SD 5.4°) external TFR in SPI, and 2.5° (SD 5.8°) internal TFR in controls (P=0.0089). FOD patients had significantly greater external tibial rotation than the SPI group (P=0.047). Conclusions: The degree of TFR is correlated with severity of patellar instability, with greater external tibial rotation seen in FOD than SPI patients, while TT-TG was not different. Further information on the relationship of TFR and patellar instability will not only improve understanding of pathogenesis and prognosis, but may also direct surgical treatment strategies in refractory or severe cases. [Figure: see text][Figure: see text]

scholarly journals Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yufeng Lu ◽  
Xiaoyu Ren ◽  
Benyin Liu ◽  
Peng Xu ◽  
Yangquan Hao
Keyword(s):  
Knee Joints ◽  
Chinese Adults ◽  
Normal Knee ◽  
Tibiofemoral Rotation ◽  
Ct Analysis

scholarly journals Increased Tibiofemoral Rotation with Increasing Severity of Patellar Instability in the Pediatric Population

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0048
Author(s):  
Evan James ◽  
Alexandra Aitchison ◽  
Lindsay Schlichte ◽  
Grace Wang ◽  
Daniel Green ◽  
...  
Keyword(s):  
Patellar Instability ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Trochlear Groove ◽  
Clinical Effects ◽  
Tibiofemoral Rotation ◽  
The Relationship

Objectives: Tibiofemoral rotation (TFR), specifically external tibial rotation, has been recently identified as a potential contributing factor to patellar instability. However, no previous studies have explored the clinical effects of differing degrees of TFR in relation to patellar instability. The purpose of this study is to investigate the relationship between severity of instability with degree of TFR. Our hypothesis is that fixed or obligatory dislocators (FOD) are more likely to have increased external TFR (tibial external rotation compared to femur) than standard patellar instability (SPI) patients requiring medial patellofemoral ligament (MPFL) reconstruction, who will have similar or slightly increased external TFR compared to normal controls. Methods: A retrospective study was performed with patients from 3 cohorts from April 2009 to February 2019: FOD, SPI, and controls with normal magnetic resonance imaging (MRI) of the knee. All FOD patients from the study time frame were analyzed, while controls and SPI patients were randomly selected. Patients were included for age under 18 years and diagnosis corresponding to one of the three cohorts, and excluded for outside institution MRI, and previous MPFL reconstruction or tibial tubercle osteotomy. TFR was measured on preoperative axial MRI using the posterior femoral and tibial condylar lines (Figure 1). Tibial tubercle to trochlear groove distance (TT-TG) was measured. Intraclass correlation coefficient (ICC) was calculated among 3 measurers. Statistical analysis using ANOVA and t-test was performed with significance set at α=0.05. Results: A total of 57 patients were included, 19 in each cohort. Average age was 13.2 years (range 10-17 years), with 31 females (54%). ICC for TT-TG and TFR were 0.90 and 0.72, respectively. TT-TG differed between the controls and SPI patients (both P<0.001), and controls and FOD patients (P<0.001), but not between SPI and FOD patients (P=0.12). TFR differed among the three groups: 8.4° (SD 16.7°) external TFR in FOD, 1.6° (SD 5.4°) external TFR in SPI, and 2.5° (SD 5.8°) internal TFR in controls (P=0.0089). FOD patients had significantly greater external tibial rotation than the SPI group (P=0.047). Conclusions: The degree of TFR is correlated with severity of patellar instability, with greater external tibial rotation seen in FOD than SPI patients, while TT-TG was not different. Further information on the relationship of TFR and patellar instability will not only improve understanding of pathogenesis and prognosis, but may also direct surgical treatment strategies in refractory or severe cases.

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

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]

scholarly journals The Role of Abnormal Tibiofemoral Rotation in Pediatric and Adolescent Patellar Instability

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0007
Author(s):  
David Bernholt ◽  
Joseph D. Lamplot ◽  
Eric Eutsler ◽  
Jeffrey J. Nepple
Keyword(s):  
Patellar Instability ◽  
External Rotation ◽  
Interobserver Reliability ◽  
Cruciate Ligament ◽  
Tibial Tubercle ◽  
Case Group ◽  
Trochlear Groove ◽  
Retrospective Case ◽  
Femoral Trochlea ◽  
Tibiofemoral Rotation

Objectives: Abnormal patellofemoral tracking has been implicated in patellar instability and can be influenced by the bony anatomy and alignment of the femoral trochlea, patella, and tibial tubercle. Tibiofemoral joint rotation has been recently suggested to play a role in patellofemoral kinematics but there has been little investigation of its contribution to patellar instability, including in pediatric and adolescent patients. Methods: A retrospective case-control design was utilized. 30 patients aged 9-18 with a prior patellar dislocation and an MRI of the involved knee were included. Cases were matched for age and gender with controls without patellar instability. Patients with ACL tears, tibial eminence or tubercle fractures, or prior surgery in the involved extremity were excluded. There was no difference in gender, age, height, but BMI was higher in the case group. MRI images taken with knee in extension were analyzed. Tibial tubercle-trochlear groove (TT-TG), tibial tubercle-posterior cruciate ligament (TT-PCL), and tibiofemoral rotation were measured. All measurements were performed by a single reader with excellent intra and interobserver reliability for tibiofemoral rotation (ICC-intra > .954 and ICC-inter > .905) demonstrated in a subset of patients. Results: The TT-TG was increased in patients with patellar instability at 16.3 mm compared to 10.9 mm in controls (p <.001) as was also the TT-PCL at 19.4 mm cases versus 17.6 mm (p=0.02). Tibiofemoral rotation was increased in patients with patellar instability with a mean 6.9° of tibial external rotation compared to 0.8° of tibial internal rotation in controls (p < .001). Overall, 30/41 (75.6%) of patients with patellar instability had tibiofemoral rotation >5° external rotation versus only 3/41 controls (7.3%). There was a strong correlation between TT-TG and tibiofemoral rotation (PCC = 0.776) and a moderate correlation between TT-TG and TT-PCL (PCC = .661). There was only a weak correlation between tibiofemoral rotation and TT-PCL. Conclusion: Increased tibiofemoral rotation is present in patients with patellar instability and may play a role in the pathophysiology of patellar instability. Increased tibiofemoral rotation can lead to an increased TT-TG even when TT-PCL is normal.

scholarly journals Tibial Torsion and Ankle Arthritis: Is External Tibial Rotation Associated with Varus Deformity in Patients with Ankle Arthritis?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Collin C. Barber ◽  
Teresa Hall ◽  
Tyler Madden ◽  
Parin D. Kothari ◽  
Monica LaPointe ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Standard Deviation ◽  
Lower Extremity ◽  
External Rotation ◽  
Varus Deformity ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
The Mean

Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: The effect of tibial torsion on lower extremity mechanical alignment has been well studied in the literature, including its effect on lower extremity osteoarthritis. It has been suggested that external tibial torsion is associated with cavus hindfoot deformity and may lead to varus osteoarthritis of the ankle. To our knowledge, there are no studies investigating this relationship. The purpose of this study is to characterize the relationship of tibial torsion with ankle coronal plane deformity in patients with ankle arthritis. Methods: The study is a retrospective, cohort of 223 patients who have undergone total ankle arthroplasty at a single institution. Preoperative computerized tomography was used to measure tibial torsion and coronal deformity. Descriptive statistics and regression analysis were used to analyze the data. Results: Descriptive analysis of all 223 patients demonstrated a maximum of 23.9 degrees varus and 20.5 degrees valgus among all patients. The mean for varus deformity was 6.86 degrees with a standard deviation of +- 6.39. Tibial rotation was calculated at an average of 20.8 degrees external rotation, with a maximum of 15.2 degrees internal rotation and 59.5 degrees external rotation in all patients. Plotting overall coronal ankle tilt versus tibial torsion revealed overall varus deformity with R2 of 0.016. Regression analysis of all varus deformities against external tibial torsion revealed a R2 of 0.02. Varus deformity 1 standard deviation above the mean against external tibial torsion demonstrated a R2 of 0.072. Valgus deformity against external tibial torsion revealed a R2 of 6.75 x10-5. Conclusion: An association between external tibial torsion and varus ankle arthritis has been proposed in the literature. The results of our study did not show an association between tibial torsion and coronal deformity in ankle arthritis in all patients undergoing total ankle arthroplasty at our institution. A difference may exist in certain subgroups, such as patients with neuromuscular disorders, but further investigation will be necessary to determine this relationship.

Measurement of Rotational Laxity of the Knee

2011 ◽  
Vol 39 (12) ◽  
pp. 2575-2581 ◽  
Author(s):  
Mahbub Alam ◽  
Anthony M.J. Bull ◽  
Rhidian deW Thomas ◽  
Andrew A. Amis
Keyword(s):  
Supine Position ◽  
External Rotation ◽  
Accurate Method ◽  
Lower Limbs ◽  
Tibial Rotation ◽  
Intraclass Correlations ◽  
The Mean ◽  
Dial Test ◽  
Ideal Method ◽  
The Ideal

Background: Posterolateral corner (PLC) injuries are difficult to diagnose and cause significant morbidity. The ideal method for the dial test and its accuracy remain unclear. Purpose: This study compares the accuracy of measuring tibial external rotation at the skeletal level to measuring the patella-tubercle angle (PTA) and the thigh-foot angle (TFA) in the supine position to assess the most accurate method to measure rotation during the dial test. Study Design: Controlled laboratory study. Methods: Measurements were compared simultaneously using rotational goniometers at a cutaneous splint over the tibia, at a foot splint, and directly from the tibial skeleton. Six lower limbs were used. The femur was held rigidly and the knee tested at 90° and 30° of flexion. External rotation torque up to 8 N·m was applied through the foot splint, and the rotations were measured by 2 testers. Results: Measurements at the tibial splint and directly on the tibia showed significant correlation at both knee flexion angles. The mean tibial external rotation was 24° at 90° of flexion and 26° at 30° of flexion ( P < .05). The soft tissue effect caused the tibial splint to overestimate rotations by a mean of 6° and 9° at 90° and 30° of flexion, respectively. Foot splint measurements did not correlate significantly with tibial rotation, overestimating rotations by a mean of 103%. Intratester and intertester intraclass correlations were significant for the skin-mounted tibial splint measurements at both flexion angles but not for foot splint measurements at either flexion angles. Conclusion: Rotation of the foot did not accurately represent the tibial external rotation at the knee, which could be measured more accurately by an instrument resting on the skin via a molded tibial splint. These results suggest that the PTA, and not the TFA, should be used in the dial test. This would support the use of the supine position during the dial test. Clinical Relevance: The dial test is a commonly used method for diagnosing PLC injuries. This study helps to identify the ideal position and measuring points to use for this test; measurements based on the tibia were more accurate than those that used rotation of the foot.

Accuracy of Corrective Osteotomies in Fibular Malunion: A Cadaver Model

2009 ◽  
Vol 30 (8) ◽  
pp. 773-777 ◽  
Author(s):  
Jan Heineck ◽  
Alexandre Serra ◽  
Cornelius Haupt ◽  
Stefan Rammelt
Keyword(s):  
External Rotation ◽  
Plate Fixation ◽  
Lower Leg ◽  
Postoperative Results ◽  
Operative Correction ◽  
Fibular Fracture ◽  
Ct Analysis ◽  
The Mean ◽  
Accurate Imaging ◽  
Formalin Fixed

Background: While incorrect length of a fibular fracture reduction can be measured by plain radiographs, accurate imaging of rotational deformities requires computed tomography (CT). Operative correction of fibular malrotation has not been accurately measured. The aim of this study was to evaluate the accuracy of operative correction of fibular malrotation. Materials and Methods: Six pairs of formalin-fixed, lower leg cadaver specimens had shortening with additional internal or external rotation induced by segmental fibular resection and plate fixation. The deformity was measured by CT. Two experienced surgeons performed standardized corrective operations on six specimens each. The postoperative results were measured by CT. Results: The mean overall accuracy for correction of malrotation was 1.58 degrees (SD = 0.8 degrees). There were no significant differences between the two surgeons performing the corrections. Conclusion: The accuracy of operative correction of malrotation in this cadaver model is in accordance with the requirements reported in clinical studies. Clinical Relevance: Considering the error margin for CT analysis, correction within 5 to 10 degrees seems practical.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

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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