Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation

Wagenaar, Frank-Christiaan B.M.; Koëter, Sander; Anderson, Peter; Wymenga, A. B.

doi:10.1016/j.knee.2006.10.009

Cited by 46 publications

(46 citation statements)

References 14 publications

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“…An increase in the lateral offset of the tibial tubercle is one anatomic abnormality that may predispose a patient to have lateral patellar instability develop [7,29]. Before proceeding with surgery to reduce the TT-TG distance [5,10,18,30], some surgeons would prefer to know this distance is pathologic in relation to that of healthy control subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Before proceeding with surgery to reduce the TT-TG distance [5,10,18,30], some surgeons would prefer to know this distance is pathologic in relation to that of healthy control subjects. Measuring the TT-TG distance using CT images is well established and is considered the gold standard [13,20,23,29]. Owing to better observation of soft tissues and the absence of radiation, the use of MRI to measure this distance is increasing [2,3,20,21,30], although the evidence for doing so is lacking [23].…”

Section: Discussionmentioning

confidence: 99%

“…An increase in the TT-TG distance is one anatomic abnormality that may contribute to this condition [7,29]. Procedures aimed at correcting the lateral offset of the extensor mechanism involve transferring the tibial tubercle medially or anteromedially [5,10,17,18,30].…”

Section: Introductionmentioning

confidence: 99%

“…One deficiency is in defining which landmarks should be chosen to measure lateral offset. The tibial tubercle and the osseous trochlear groove are uniform landmarks in numerous studies using CT [7,12,13,16,29], but better observation of soft tissues has led to variability in landmark selection in studies using MR images [2,3,14,20,30]. One study [20] compared MR and CT images for measurement of lateral offset using traditional osseous landmarks and a more functional soft tissue landmark (the distance from the center of the patellar tendon to the trochlear groove [PT-TG]), concluding that there was no difference and that they could be used interchangeably.…”

Section: Introductionmentioning

confidence: 99%

“…An additional deficiency is defining the reliability of using MR images to measure this distance. Interobserver and intraobserver reliabilities and other measures of variability using CT images to measure the TT-TG distance have been defined [13,20,29]. Only one study has assessed interobserver reliability using MR images to measure the lateral offset (82%), but does not asses the intraobserver reliability of this measurement.…”

Section: Introductionmentioning

confidence: 99%

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Does Landmark Selection Affect the Reliability of Tibial Tubercle-Trochlear Groove Measurements Using MRI?

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Aoki

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background A lateralized tibial tubercle is one potential cause of patellar instability. The tibial tubercle-trochlear groove (TT-TG) distance using CT is a reliable measure and considered the gold standard. Using MRI for this purpose has increased, although the reliability of doing so is not well studied. Questions/purposes We sought to (1) determine variability in the insertion of the patellar tendon relative to the tibial tubercle and whether this affects the measurement on MRI of the traditional TT-TG distance versus the functional patellar tendon-trochlear groove (PT-TG) distance, (2) determine the reliability of measuring the osseous TT-TG distance, (3) determine the reliability of measuring the soft tissue PT-TG distance, and (4) compare the reliabilities of using osseous (TT-TG) versus soft tissue (PT-TG) landmarks. Methods Four observers measured the TT-TG and the PT-TG distances of 50 MR images of knees obtained for any reason. Each observer repeated these measurements 30 days later. The interobserver and intraobserver reliabilities, measurements per observer that varied from the group mean by greater than 2 mm, and the limit of agreement were calculated. Results The TT-TG and PT-TG differed by as little as 0.11 mm and by as much as 4.18 mm with an average difference of 1.37 mm. The interobserver and intraobserver reliabilities were greater than 90% for the PT-TG and TT-TG distances. The PT-TG distance was less variable in that this measurement showed interobserver and intraobserver reliabilities of 0.977 and 0.972 respectively, versus 0.913 and 0.961 for the TT-TG measurement. Additionally, the PT-TG measurements resulted in a lower average difference to the mean for each observer, less number of knees per observer where the difference to the mean was greater than 2 mm, and improved limit of agreement. Conclusions The TT-TG and the PT-TG distances were not identical and differed by as much as 4.18 mm; as such they are not interchangeable when measuring this distance.

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