Tibial tubercle malposition in patellar joint instability: A computed tomography study in full extension and at 30° flexion

Miyanishi, Keita; Nagamine, Ryuji; Murayama, Sadayuki; Miura, Hiromasa; Urabe, Ken; Matsuda, Shinya; Hirata, Go; Iwamoto, Yukihide

doi:10.1080/000164700317411898

Cited by 36 publications

(30 citation statements)

References 17 publications

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“…7,10,20,23,36 Previous studies have documented excellent interrater and intrarater reliability for CT measurements of TT-TG offset, but there is at least 1 study that shows an interrater difference of 3.2 mm on consecutive reads. 20,21,24,29,31 Our reliability was somewhat less than that reported by others, which we attribute to the subjectivity that comes with deciding which CT slice is most appropriate at each level for measuring TT-TG offset.…”

Section: Discussioncontrasting

confidence: 55%

Measurement of Tibial Tuberosity–Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan

Marzo

Kluczynski

Notino

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Computed tomography (CT) scans are useful for objectively measuring bone alignment because they show bone detail particularly well, and these scans have been used extensively to assess patellar orientation. The tibial tubercle–trochlear groove (TT-TG) offset distance has been shown to be influenced by knee flexion and weightbearing, yet conventional CT scans are obtained with the subject relaxed, supine, and with the knee in full extension. A new cone-beam CT scanner has been designed to allow for weightbearing images, potentially providing a more physiologically relevant assessment of patellofemoral alignment.Purpose/Hypothesis:The purpose of this study was to measure the TT-TG offset in healthy individuals without any history of knee complaints when CT scans were obtained while fully weightbearing on a flexed knee. Our hypothesis was that the TT-TG offset measurement in these healthy knees would be reproducible and less than the historically reported normal range.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Twenty healthy volunteers without any history of knee complaint were recruited to undergo a weightbearing cone-beam CT scan of the knee flexed at 30°. The scans were reviewed by a radiologist and an orthopaedic surgeon, and TT-TG offset was measured using the digital tools of a picture archiving and communication system. Paired t tests were used to compare TT-TG offset on 2 separate occasions for both raters. Inter- and intrarater reliability were assessed using a 2-way mixed-effects model intraclass correlation coefficient with corresponding 95% confidence intervals for TT-TG offset.Results:The mean TT-TG offset was 2.7 mm. There were no statistically significant differences in TT-TG offset between raters (P rater1 = .70; P rater2 = .49) and time of read (P time1 = .83; P time2 = .19). Good to moderate interrater reliability was found at the time of both reads, and good intrarater reliability was found for both raters.Conclusion:When measured by CT scan and obtained from a subject while weightbearing on a flexed knee, the TT-TG offset is reproducible and the distance is less than that obtained via a conventional CT scan.

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Section: Discussioncontrasting

confidence: 55%

Measurement of Tibial Tuberosity–Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan

Marzo

Kluczynski

Notino

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…50 In full extension, the tibia is externally rotated thereby shifting the TT laterally and increasing the TT-TG distance. With the knee flexed, the tibia rotates internally with an associated reduction in the TT-TG distance.…”

Section: Radiologic Assessment Of Tibial Tuberosity Lateralizationmentioning

confidence: 99%

Distal Realignment (Tibial Tuberosity Transfer)

Feller¹

2012

Sports Medicine and Arthroscopy Review

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Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

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“…It is known that quadriceps muscular contraction and knee flexion which occur in weight-bearing influence patellar stability and alignment [8]. Moreover, the evidence from the literature supports the fact that removing these conditions can affect stability and alignment parameters measurement [9][10][11][12].…”

Section: Introductionmentioning

confidence: 82%

“…However, some image-based studies conducted via MRI with patients in weight-bearing and/or with the knee flexed, opened the way to further investigations of patellofemoral stability and alignment in these conditions. By using MRI and with patient supine, it has been shown that there is a significant progressive reduction in TT-TG offset when the knee is imaged from 0° to 90° [9][10][11][12]. Realtime MRI was used to acquire patellofemoral kinematics during dynamic knee extension from 30° to 0° in supine mimicking weight-bearing [26]; this study advocates that patellofemoral kinematics measured during supine position does not accurately represent patellar motion during weight-bearing activities.…”

Section: Discussionmentioning

confidence: 99%

Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation

et al. 2021

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Purpose To compare weight-bearing cone-beam computer tomography (CBCT) and conventional computer tomography (CT)-based measurements of patellofemoral alignment and stability in patients surgically treated for recurrent patellar dislocation. These scans implied respectively single-leg up-right posture, the knee flexed, and lower limb muscles activation, versus supine position with the knee extended. Methods A total of 17 patients (11 males/6 females) after surgical reconstruction with fascia lata allograft for recurrent patellofemoral dislocation were analyzed at 60-month follow-up. Tilt and congruence angles and tibial tuberosity–trochlear groove (TT-TG) offset were measured on images obtained from CBCT and conventional CT scans by three independent and expert radiologists. Paired t tests were performed to compare measurements obtained from the two scans. Inter-rater reliability was assessed using a two-way mixed-effects model intra-class correlation coefficient (ICC). Results Only TT-TG offset was found significantly smaller (p < 0.001) in CBCT (mean 9.9 ± 5.3 mm) than in conventional CT (mean 15.9 ± 4.9 mm) scans. ICC for tilt and congruence angles and for TT-TG offset ranged between 0.80–0.94 with measurements in CBCT scans, between 0.52 and0.78 in conventional CT. Conclusion In patients surgically treated for recurrent patellar dislocation, TT-TG offset was found overestimated with conventional CT. All measurements of patellofemoral stability and alignment were found more consistent when obtained with weight-bearing CBCT compared to conventional CT.

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Tibial tubercle malposition in patellar joint instability: A computed tomography study in full extension and at 30° flexion

Cited by 36 publications

References 17 publications

Measurement of Tibial Tuberosity–Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan

Measurement of Tibial Tuberosity–Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan

Distal Realignment (Tibial Tuberosity Transfer)

Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation

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