The tibial–tubercle trochlear groove distance in patients with trochlear dysplasia: the influence of the proximally flat trochlea

Tscholl, Philippe M.; Antoniadis, Alexander; Dietrich, Tobias Johannes; Koch, Peter P.; Fucentese, Sandro F.

doi:10.1007/s00167-014-3386-6

Cited by 26 publications

(28 citation statements)

References 28 publications

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“…A slice in the axial plane of the scanner was generated at the most proximal deepening of the trochlear groove spanned by cartilage. 12 The trochlear groove point was set at the deepest point of the trochlear groove within this slice. The posterior femoral condylar axis was also identified on this slice as a line connecting the most posterior aspects of the medial and lateral femoral condyles.…”

Section: Methodsmentioning

confidence: 99%

Variations in Tibial Tuberosity to Trochlear Groove and Posterior Cruciate Ligament Distances due to Tibial External and Valgus Rotations

et al. 2017

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Tibial rotations with respect to the femur influence measurements used to assess the lateral position of the tibial tuberosity. This study utilized computational modeling to quantify how the tibial tuberosity to trochlear groove (TT-TG) and tibial tuberosity to posterior cruciate ligament attachment (TT-PCL) distances vary with tibial internal/external and varus/valgus rotations. Computational models were developed from magnetic resonance imaging data to represent eight knees with patellar instability. TT-TG and TT-PCL distances were quantified from the computational models for a neutral orientation and with the tibia rotated internally and externally and into varus and valgus in 1-degree increments to 5 degrees. Regression analyses related tibial rotations to TT-TG and TT-PCL distances. TT-TG distance increased with tibial external rotation, and both TT-TG and TT-PCL distances increased with valgus orientation ( > 0.94 for all regressions). The average increase in TT-TG distance for each 1 degree of tibial external rotation was 0.55 mm (range: 0.50-0.62 mm), compared with 0.00 mm (range: -0.05 to 0.04 mm) for TT-PCL distance. The average increase in TT-TG distance for each 1 degree of valgus was 1.01 mm (range: 0.91-1.14 mm), compared with 0.46 mm (range: 0.32-0.60 mm) for TT-PCL distance. TT-TG distance varies more with tibial rotations than TT-PCL distance due to both points being on the tibia and a smaller proximal-distal distance between the points for TT-PCL distance.

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Section: Methodsmentioning

confidence: 99%

Variations in Tibial Tuberosity to Trochlear Groove and Posterior Cruciate Ligament Distances due to Tibial External and Valgus Rotations

et al. 2017

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“…37,39 In particular, MRI in a dedicated knee coil may underestimate the TTTG distance compared with CT. 42 Anatomical variances and trochlear dysplasia also plays a crucial role in TTTG measurements: It was hypothesized that the reference point of the trochlear groove in trochlear dysplasia is more inferior lateral in comparison with normal trochlear grooves. 43 As a consequence the TTTG distance is underestimated up to 3 mm in knees with trochlear dysplasia compared with normal knees. 43 Furthermore, a decreasing inter-and intraobserver agreement was found with an increasing severity of trochlear dysplasia.…”

Section: Tuberosity To the Trochlear Groove Distancementioning

confidence: 98%

“…43 As a consequence the TTTG distance is underestimated up to 3 mm in knees with trochlear dysplasia compared with normal knees. 43 Furthermore, a decreasing inter-and intraobserver agreement was found with an increasing severity of trochlear dysplasia. 44 The center of the patellar tendon at its tibial insertion as a soft tissue landmark is a more constant reference point and provides a higher interobserver and intraobserver agreement for TTTG measurements for surgical planning than its widely used osseous counterpart, the most anterior aspect of the tibial tubercle.…”

Section: Tuberosity To the Trochlear Groove Distancementioning

confidence: 98%

Imaging of Individual Anatomical Risk Factors for Patellar Instability

Dietrich

Fucentese

Pfirrmann

2016

Semin Musculoskelet Radiol

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This review article presents several pitfalls and limitations of image interpretation of anatomical risk factors for patellar instability. The most important imaging examinations for the work-up of patients with patellar instability are the true lateral radiograph and transverse computed tomography (CT) or MR images of the knee. Primary anatomical risk factors are an insufficient medial patellofemoral ligament (MPFL), patella alta, trochlear dysplasia, increased distance from the tibial tuberosity to the trochlear groove (TTTG), and torsional limb parameters. Limitations of the Caton-Deschamps index are related to the clear identification of the patellar and tibial articular margin. Classification of trochlear dysplasia according to the Dejour system on radiographs and MR images revealed a weak reliability. The comparability of TTTG values obtained on CT and MR images at various flexion angles and different varus alignments of the knee is limited. Thus MRI performed with a dedicated knee coil may underestimate the TTTG distance compared with CT images. Increased lateral patellar tilt is a consequence of primary anatomical risk factors rather than an independent anatomical risk factor for patellar instability. The pretest likelihood of a torn MPFL on MR images is very high after an acute episode of lateral patellar dislocation. Surgical restoration of the patellofemoral joint stability addresses the complex multifactorial biomechanics by a custom-made management such as MPFL reconstruction, sulcus-deepening trochleoplasty, as well as medialization and distalization of the tibial tubercle. Quantification of anatomical risk factors for patellar instability in each person is important for highly individual treatment.

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“…4,5 The medialized groove causes the tibial tubercle-trochlear groove distance to increase, the low lateral inclination angle decreases the osseous stability, and the tilt occurs as a consequence of the patella articulation with the lateral facet only. 6 The trochleoplasty procedure seems to more or less normalize these anatomical issues 7 and correspondingly it provides good clinical results. This is illustrated by multiple studies in which improvements in patella stability, reduction of anterior knee pain (AKP), and better quality of life have been shown compared with other surgical procedures in cases with severe trochlear dysplasia.…”

mentioning

confidence: 99%