The Normal Value of Tibial Tubercle Trochlear Groove Distance in Patients with Normal Knee Examinations Using MRI

Abstract

Patellar instability is a multifactorial common knee pathology that has a high recurrence rate, and the symptoms continue and ultimately predispose the patient to chondromalacia and osteoarthritis. Tibial tuberosity-trochlear groove distance (TTTG) is very important in the assessment of patellofemoral joint instability. The purpose of this study was to report normal value of TTTG in males and females in different age groups and to assess the reliability of MRI in measuring TTTG. All patients presenting with knee pain and normal examinations of knee joint, with a normal MRI report, referring to ShahidSadoughi hospital of Yazd, Iran, from April 2014 to September 2014, were included into the study. MR images were studied once by two radiologists and for the second time by one radiologist. Mean value of TTTG was reported for males and females and in three age groups. Intra-and inter-observer reliability was calculated. A total of 98 patients were eligible to evaluate during 6 months (68 male and 30 female). Mean TTTG was 10.9 ± 2.5 mm in total, which was 10.8 ± 2.8 mm and 11.3 ± 2.3 mm in males and females, respectively (P > 0.05). Mean TTTG in males ≤ 30 years, 30-50 years and, ≥ 51 years old were 10.8 ± 2.6 mm, 10.8 ±2.7 mm, and 10.8 ± 2.6 mm, respectively; that was 12.1 ± 3.4 mm, 11.4 ± 1.9 mm, and 10.5 ± 1.7 mm in females ≤ 30 years, 31-50 years and, ≥ 51 years old, respectively (95 % CI). The coefficient of variation was < 10% for both intra-and inter-observer analysis. The results of the present study showed no significant difference in TTTG value between males and females in different age groups. In addition, it demonstrated that MRI is a reliable method in assessment of TTTG and identified normal value for TTTG at 10.9 ± 2.5 mm.

Relationship of the tibial tuberosity (TT) position, tibial tuberositytrochlear groove (TT-TG) distance, and internal and external rotation of the knee under weight-bearing conditions

“…In this study, we investigated the relationship between TT position, TT-TG distance, and internal/external rotation under weight-bearing conditions. The TT-TG distance values ranged between 5-17 mm in extension, which is considered as being normal [12,13]. Our results showed an overall tendency of decreased TT-TG distance values over knee flexion, which coincides with previous findings [8,7].…”

Evaluation of the normal tibial tubercle-trochlear groove distance with magnetic resonance imaging in a Turkish population

“…In the study by Pandit et al [11], 100 patients with suspected meniscus injury and normal arthroscopy were examined, and the mean TT-TG distance was found to be 10 ± 1 mm; 9.91 mm in males and 10.04 mm in females, while Wittstein et al [13]found the mean value of TT-TG distance to be 9.4 ± 0.6 mm. In another study, Schoettle et al [12] compared the reliability of CT scanning with MRI and calculated the mean TT-TG value as 13.5 ± 4.6 mm on MRI, which is higher than the value reported by Pandit et al [11] and Sobhanardekani et al (14). Hingelbaum et al compared the MRI scans of 200 knees using similar to Shoettle et al method and found that the TT-TG values of the different sexes were not statistically different, with the mean TT-TG distance in the control group being 7.5 ± 3.5 mm compared to 13.5 ± 4.1 mm in the patient group [15].…”

“…Hingelbaum et al compared the MRI scans of 200 knees using similar to Shoettle et al method and found that the TT-TG values of the different sexes were not statistically different, with the mean TT-TG distance in the control group being 7.5 ± 3.5 mm compared to 13.5 ± 4.1 mm in the patient group [15]. In the study conducted by Sobhanardekani et al [14]in Iranian patients, the mean TT-TG distance was reported to be 10.9 ± 2.5 mm, with similar TT-TG values between sexes. In the adult Indian population, the mean normal value of the TT-TG distance was calculated as 13.54 ± 6.22 mm (13.19 ± 6.28 mm in males; 14.07 ± 6.06 in females) [2].…”

“…In the literature, the inter-rater and intra-rater reliability of TT-TG measurement via MRI has been reported to be less than 10 percent. This study has shown that MRI is a reliable method for the evaluation of TT-TG [7,11,14,16].…”

A ressonância magnética do joelho usando a bobina de corpo é equivalente à TC na medição da distância TT-ST: Removendo o viés sistemático

“…When TT-TG measurement is necessary, the CT study can be substituted by an axial T1-weighted sequence of the knees using the body coil, removing the need of unnecessary radiation exposure in this setting and, most importantly, allowing the use of the same threshold (15-20 mm) classically used in CT. Our study also confirms the excellent interrater reliability of MRI measurements, which had already been shown in previous studies. 14,17,18 Schoettle et al 19 compared knee CT and MRI (with a routine knee protocol) and found an excellent intermethods reliability, stating that additional CT scans were not necessary. However, many later studies have not been able to reproduce these results, concluding that CT and MRI TT-TG measurements are not equivalent, and that MRI measurements are systematically underestimated, 3,4,7-9 which suggests it would be inaccurate to use the same threshold in MRI and CT in diagnosis and surgical planning.…”