Validating the Role of Tibial Tubercle–Posterior Cruciate Ligament Distance and Tibial Tubercle–Trochlear Groove Distance Measured by Magnetic Resonance Imaging in Patients With Patellar Dislocation: A Diagnostic Study

Xu, Zongbin; Zhang, Hua; Yan, Wenlong; Man, Qiu; Zhang, Jian; Zhou, Aiguo

doi:10.1016/j.arthro.2020.09.004

Cited by 28 publications

(44 citation statements)

References 30 publications

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“…We also analyzed the diagnostic efficacy of each TT-TG distance for PD and found that the TT-TGp distance had a good diagnostic capacity, with an AUC of 0.811, which was almost equivalent to the results reported by Xu et al, (AUC = 0.820) [ 14 ]. While the TT-TGs and TT-TGa distance had a fair capacity, with an AUC of 0.777 and 0.768, respectively.…”

Section: Discussionsupporting

confidence: 75%

“…The TT-TG distance measured by CT images was unreliable, because the measurement was greatly affected by dysplastic femoral trochlea [ 12 ]. On the other hand, previous literature suggested that the TT-TG distance can be reliably measured by MRI, because the cartilage of femoral trochlea can be clearly visualized and the entry of the trochlea can be accurately located by MRI [ 14 , 25 ]. The results of our study showed that all the three TT-TG distances measured by MRI had excellent interobserver agreements, even in patients with severe trochlear dysplasia.…”

Section: Discussionmentioning

confidence: 99%

“…Receiver operating characteristic curves (ROC) and the areas under the curves (AUC) were analyzed to evaluate the diagnostic capacity of the parameters for PD via GraphPad Software (version 8.0.2, San Diego, CA, USA). An AUC greater than 0.7 indicates fair to good capacity [ 14 ]. The data in the control group were used to identify the pathological threshold value of each TT-TG distance.…”

Section: Methodsmentioning

confidence: 99%

“…We established the Binary logistic regression model based on the pathological value of the TT-TG distances to identify the anatomical risk factors for PD. The intraclass correlation coefficients (ICCs) of the TT-TG distances in different degrees of trochlear dysplasia were calculated to identify the reliabilities, with a value more than 0.75 indicating excellent agreement [ 14 ]. We defined α as 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…The femoral trochlear morphology distinctly influences the measurement of the TT-TG distance and it is difficult to identify the deepest portion of the femoral trochlea, even the trochlea itself in patients with severe trochlear dysplasia [ 11 , 12 ]. On the other hand, such measurement was verified reliable on axial magnetic resonance imaging (MRI) cuts [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation

Zhao

Chen

Feng

et al. 2022

JCM

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Background: The tibial tubercle to trochlear groove (TT-TG) distance is currently considered as an indication for tibial tubercle osteotomy. While the influence of femoral condylar morphology on such measurement remains unclear. Methods: A total of 86 patients with patellar dislocation (PD) and 86 healthy individuals were enrolled. Femoral condylar morphology and the TT-TG distance measured by anatomical transepicondylar axis (TT-TGa), by surgical transepicondylar axis (TT-TGs), and by posterior condylar reference line (TT-TGp) were assessed by MRI. Unpaired t-test, Spearman, and Pearson correlation analysis were conducted. We determined the pathological value of the parameters and established a binary regression model. Results: The interclass correlation coefficients of all the TT-TG distances were greater than 0.75 in all types of trochlear dysplasia. The lateral/posterior femoral condyle was shorter and the medial/posterior condyle was longer in the study group (28.5 ± 3.3 and 35.2 ± 2.8, respectively) than in the control group (30.9 ± 2.7 and 33.5 ± 2.3, respectively). In the study group, the TT-TGp distance was greater than TT-TGs and TT-TGa distance (p < 0.001). The pathological value of the TT-TG distance was 13.0 mm. Each TT-TG distance revealed a significant OR with regard to PD. Conclusion: The TT-TGa, TT-TGs, and TT-TGp distance can be reliably measured by MRI even in patients with trochlear dysplasia. While the TT-TGp distance may overestimate the lateralization deformity of the tibial tubercle. Posterior femoral condylar dysplasia may be a reason for such overestimating. These findings have not been correlated to clinical outcomes and further studies are required.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation

Zhao

Chen

Feng

et al. 2022

JCM

Self Cite

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Tibial Tubercle Anteromedialization Osteotomy (Fulkerson Osteotomy)

Gudeman

Farr

2023

Anterior Knee Pain and Patellar Instability

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Ipsilateral patellofemoral morphological abnormalities are more severe than those of contralateral joints in patients with unilateral patellar dislocation

Chen

Zhang

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeTo determine the differences in anatomic parameters between ipsilateral dislocated knees and contralateral non‐dislocated knees in patients with unilateral patellar dislocation and to identify any variations in ipsilateral knees contributing to contralateral anatomic abnormalities. MethodsA total of 82 patients with unilateral patellar dislocation from 2016 to 2019 were retrospectively evaluated. Bilateral anatomic factors, including the tibial tubercle to trochlear groove (TT‐TG) distance, lower limb rotational deformities, trochlear dysplasia, patella tilt, and patellar height, were assessed by CT. ResultsThe study included 46 patients (32 females and 14 males, mean age ± SD 20.5 ± 6.8). The interobserver reliability of each parameter showed excellent agreement. The ipsilateral TT‐TG distance (P = 0.004), patella tilt (P = 0.001), and patellar height (P = 0.01) were greater in the ipsilateral knees than in the contralateral knees. The lateral trochlea inclination (LTI) in the contralateral knees was larger than that in the ipsilateral knees (P = 0.022). There was a significant difference in the distribution of trochlear dysplasia of Dejour between the ipsilateral knees (dislocated side) and the contralateral knees (P = 0.036). However, bilateral femoral and/or tibial torsion, and bilateral knee joint rotation did not differ significantly. Binary logistic regression showed that only ipsilateral LTI revealed significant ORs of 8.83 (P = 0.016) and 7.64 (P = 0.018) with regard to contralateral abnormal tibial torsion and LTI, respectively. ConclusionIn patients with unilateral patellar dislocation, the ipsilateral TT‐TG distance, patella tilt, and patellar height values were larger in the ipsilateral knees than in the contralateral knees, and trochlear dysplasia was more severe in the ipsilateral joints. The risks of contralateral pathological tibial torsion and LTI were 8.8‐ and 7.6‐fold higher, respectively, in patients with abnormal ipsilateral LTI. Level of evidenceLevel IV.

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Validating the Role of Tibial Tubercle–Posterior Cruciate Ligament Distance and Tibial Tubercle–Trochlear Groove Distance Measured by Magnetic Resonance Imaging in Patients With Patellar Dislocation: A Diagnostic Study

Cited by 28 publications

References 30 publications

Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation

Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation

Tibial Tubercle Anteromedialization Osteotomy (Fulkerson Osteotomy)

Ipsilateral patellofemoral morphological abnormalities are more severe than those of contralateral joints in patients with unilateral patellar dislocation

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