Tibial Tubercle–Posterior Cruciate Ligament Distance

Seitlinger, Gerd; Scheurecker, Georg; Högler, R.; Labey, Luc; Innocenti, Bernardo; Hofmann, S.

doi:10.1177/0363546512438762

Cited by 218 publications

(138 citation statements)

References 17 publications

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“…Conventionally, clinical evidences of lateral patella tracking in combination with values of 20 mm and greater have been classified as excessive TT-TG with a recommendation to include an anteromedialization (AMZ) TTO in the treatment of recurrent instability [17,22,23]. Several authors have advocated for the use of TT-posterior cruciate ligament (TT-PCL) with a distance > 24 mm as the threshold for distal realignment as TT-PCL relies exclusively on tibial landmarks, eliminating the influence of femoral rotation [24][25][26]. Although TT-TG remains the more widely accepted method, there may be considerable benefit to the use of TT-PCL in the setting of Dejour type B, C, or D trochlear dysplasia due to the inherent challenges in identifying an abnormal or absent trochlear groove.…”

Section: Tibial Tubercle-trochlear Groove Distancementioning

confidence: 99%

Avoiding Complications with MPFL Reconstruction

Smith

Werner

Diduch

2018

Curr Rev Musculoskelet Med

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Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.

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Section: Tibial Tubercle-trochlear Groove Distancementioning

confidence: 99%

Avoiding Complications with MPFL Reconstruction

Smith

Werner

Diduch

2018

Curr Rev Musculoskelet Med

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“…Some factors signiﬁcantly inﬂuence this measurement. The TT-TG distance is sensitive to knee rotation, small changes in femoral alignment and axial CT or MRI scan orientation[ 45 , 46 ]. In addition, low reproducibility of the measurement has been described, with an error of about 3-4 mm depending on the slices selected and the landmarks chosen by the radiologist[ 47 ].…”

Section: Is Radiological Assessment Helpful In Decision Making When Omentioning

confidence: 99%

“…The tibial tubercle-posterior cruciate ligament (TT-PCL) distance has been recently introduced as a measurement not influenced by the rotation of the knee or the shape of the trochlea (Figure 11 )[ 45 ]. Similarly, the new TT-TG index allows for correlation of the distance with individual joint size, which is especially important in cases of marginal TT-TG distance[ 48 ].…”

Section: Is Radiological Assessment Helpful In Decision Making When Omentioning

confidence: 99%

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Sanchis-Alfonso

Montesinos-Berry

Ramírez-Fuentes

et al. 2017

WJO

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Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.

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“…[47,48] When assessing PFJI patients with marked trochlear dysplasia, a tibial tuberosity-PCL (TT:PCL) distance can be more useful instead of a TT:TG distance in determining the location of the tibial tuberosity independent of the trochlear shape, given that high TT:TG could result from either tibial tuberosity lateralization or trochlear groove medialization without discrimination. [49]…”

Section: Trochleoplastymentioning

confidence: 99%

Recent advances and future trends in patellofemoral instability

Anand

Kambhampati³

2020

JASSM

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Patellofemoral joint instability (PFJI) is a challenging condition affecting primarily young patients. It can be both physically and mentally disabling. There are numerous factors which contribute to stability of the patellofemoral joint and thorough clinical assessment and appropriate radiological investigations are essential in determining which risk factors need to be corrected to prevent further episodes of dislocation. One of the key operations utilized in the management of PFJI is medial patellofemoral ligament (MPFL) reconstruction, to restore the patellar restraint against lateral translation. The complications that can result from MPFL reconstruction can be largely divided into complications resulting from technical error or selection of operation for a patient’s specific risk factors. Some risk factors of PFJI can precipitate the need for additional operations being performed alongside MPFL reconstruction, including trochleoplasty, lateral retinacular lengthening, and tibial tuberosity osteotomy. Failure to identify the need for concurrent operations will result in persistent PFJI. This update article will outline the approach to assess a patient presenting with PFJI and the risk factors which should be identified and corrected. It will also cover the various management options with respect to these factors, with some important considerations for each.

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Tibial Tubercle–Posterior Cruciate Ligament Distance

Abstract: Only 57% of the patients with a pathological TT-TG distance (≥20 mm) had lateralization of the tibial tubercle in relation to the posterior cruciate ligament. The TT-PCL distance is an alternative method for determining the position of the tibial tubercle.

Cited by 218 publications

References 17 publications

Avoiding Complications with MPFL Reconstruction

Avoiding Complications with MPFL Reconstruction

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Recent advances and future trends in patellofemoral instability

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