Value of the Tibial Tuberosity–Trochlear Groove Distance in Patellar Instability in the Young Athlete

Balcarek, Peter; Jung, Klaus; Frosch, Karl‐Heinz; Stürmer, K. M.

doi:10.1177/0363546511404883

Cited by 181 publications

(172 citation statements)

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“…Hingelbaum et al hypothesized that a TT-TG distance of more than 20 mm in a large knee may have a much smaller pathological impact on patellofemoral alignment than in a smaller knee [2]. Therefore, recent literature has introduced various indices evaluating TT-TG as a ratio of joint size: the TT-TG/TT-TE ratio expresses TT-TG in relation to the proximal-distal joint size [2] and the TT-TG/femur width ratio in relationship to the medio-lateral width of the distal femur [3,4]. Also, Camp et al studied a patellar instability ratio in order to individualize the TT-TG distance.…”

Section: Introductionmentioning

confidence: 99%

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic

Runer

Dirisamer

et al. 2017

International Orthopaedics (SICOT)

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Purpose The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. Methods This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, mediolateral width of the tibia, width of the patella and the proximaldistal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. Results In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. Conclusions Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. Level of evidence Level III

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Section: Introductionmentioning

confidence: 99%

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic

Runer

Dirisamer

et al. 2017

International Orthopaedics (SICOT)

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“…Some previous studies have shown no difference between two groups. 4,8 Although the TT-TG distance is used in the evaluation of patellar instability to make the decision for alignment surgery, quantitative evaluation has been shown to be very difficult in literature. 19,20 In the normal population, the TT-TG distance has been reported to be mean 13 mm.…”

Section: Discussionmentioning

confidence: 99%

“…21 There have been many studies in literature which do not conform with the criteria of a threshold value of 20 mm. 4,8,11 It has also been shown that these values may change according to whether the evaluation is by MRI or CT. 3 Again because of differences in the measurement points selected, standardized measurement of the TT-TG distance has not yet been achieved. 8,22 Changes may be seen according to the patient's age, gender, and height.…”

Section: Discussionmentioning

confidence: 99%

“…TT-TG: tibial tubercle to trochlear groove distance; TT-PT: tibial tubercle to patellar tendon midpoint distance; TT-TD: tibial tubercle to tuberositas tibia apex of the dome; GPA: the angle between trochlear groove and patellar tendon axis; GDA: the angle between trochlear groove and tuberositas tibia dome axis. 4 Journal of Orthopaedic Surgery 0(0) than the TT-TG distance. 16 In the current study, the change in the TT-TG distance and the change in the PT-TG distance were found to be correlated and the values were consistent with those in literature.…”

Section: Discussionmentioning

confidence: 99%

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Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters

Devecı

Çankaya

Yılmaz

et al. 2017

J Orthop Surg (Hong Kong)

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Purposes: When the evaluation of patellar instability is examined from the aspect of the conical-cylindrical anatomy of the tibia, metric measurement parameters such as the tuberositas tibia (TT)-trochlear groove (TG) and patellar tendon (PT) insertion-trochlear groove (TG) distances are not sufficient. We asked whether defined angular parameters reveal the rotational movement of the tuberositas tibia on the tibia shaft, additional to the metric parameters and there is a correlation between the metric and angular parameters. Methods: 19 patients with patellar instability and 22 patients without patellar instability were evaluated. For all patients, two angle and three length parameters were evaluated on the slices taken. Evaluations were made of the TT-TG, the midpoint of the PT insertion-TG distances, the anatomic midpoint of the dome of the TT-TG, the TG-PT angle, and the TG-dome angle (DA). The Pearson correlation test was used for the statistical analysis of correlations between groups. Results: A statistically significant increase was determined in the patellar instability group in the TG-DA and TG-PT angle values compared to the group without patellar instability (p < 0.05). In both groups, a positive and strong correlation was determined between the TT-TG and the TG-PT and dome of the TT-TG distances, but no statistically significant correlation was determined between the tuberositas TT-TG and TG-PT angle and TG-DA. Conclusion: Metric parameters may not be sufficient alone in the evaluation of patellar instability. Metric parameters should be supported by additional angular parameters which reveal the rotational movement of the TT on the tibia shaft.

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“…Es ist allerdings zu beachten, dass bei ausgeprägter Trochleadysplasie keine vermessbare Vertiefung der Trochlea ausgebildet sein kann, weswegen in diesen Fällen der TT-TG nicht bestimmbar ist. Bei Kontrollgruppen ohne patellofemorale Instabilität sind TT-TG-Mittelwerte von 10 -12 mm publiziert [25,39,42]. Werte zwischen 15 -20 mm werden als grenzwertig angesehen.…”

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MRT nach Patellaluxation: Quantifizierung der Risikofaktoren und Beschreibung der Folgeschäden

Diederichs

Scheffler

2013

Fortschr Röntgenstr

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Zusammenfassung Bei der Patellaluxation handelt es sich um ein Herausspringen der Kniescheibe aus dem trochlearen Gleitlager nach lateral. In der Regel liegen anatomische Risikofaktoren in unterschiedlichem Auspr?gungsgrad vor, die in Zusammenhang mit einer Rotationsbewegung des Beines zu einem Luxationsereignis f?hren. Die im MRT problemlos diagnostizierbaren Kontusions?deme der inferomedialen Patella und des lateralen Femurkondylus sowie die Ruptur des medialen patellofemoralen Ligamentes gelten als typische Zeichen einer k?rzlich stattgehabten Luxation. Allerdings sind auch osteochondrale Begleitverletzungen m?glich, die je nach Ausma? eine Indikation zur fr?hen Refixation darstellen k?nnen. Nach dem Erstereignis folgen durch den instabilen Kapsel-Band-Apparat h?ufig weitere Luxationen, die in Abh?ngigkeit der vorliegenden anatomischen Normvarianten bis hin zu einer chronischen patellofemoralen Instabilit?t f?hren k?nnen. Therapeutisch hat sich ein breites Spektrum aus konservativen und operativen Verfahren durchgesetzt. W?hrend Erstluxationen h?ufig konservativ behandelt werden, orientiert sich das operative Verfahren nach der Zweitluxation am Verletzungsmuster und Auspr?gungsgrad der anatomischen Risikofaktoren. Die relevanten pr?disponierenden Anlagevarianten sind die Trochleadysplasie, die Patella alta und der pathologische Abstand der Tuberositas tibia zum Sulcus trochleae (TT-TG). Insgesamt sollten im radiologischen Befund sowohl die Folgesch?den der Luxation als auch die anatomischen Risikofaktoren quantifiziert werden, da eine individuelle Analyse des zugrunde liegenden Pathomechanismus ausschlaggebend f?r die optimale patientenspezifische Therapie ist.

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Value of the Tibial Tuberosity–Trochlear Groove Distance in Patellar Instability in the Young Athlete

Abstract: A lateralized tibial tubercle is a relevant anatomic factor in the young athlete and in the adult patient with lateral patellar instability. Its parameter values and its influence on patellar dislocation are independent of patient age and should therefore be evaluated as in adults.

Cited by 181 publications

References 20 publications

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters

MRT nach Patellaluxation: Quantifizierung der Risikofaktoren und Beschreibung der Folgeschäden

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