CT and MRI measurements of tibial tubercle lateralization in patients with patellar dislocation were not equivalent but could be interchangeable

Xu, Zongbin; Song, Yifan; Deng, Rong‐Hui; Ye, Jing; Wang, Xinjie; Wang, Haijun; Yu, Jia-Kuo

doi:10.1007/s00167-022-07119-8

Cited by 7 publications

(10 citation statements)

References 26 publications

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“…We have also performed studies to investigate the difference in the TT-RA distance between CT and MRI. 4 We found that the value of TT-RA distance is affected by the rotation or flexion of the knee joint, which is also the case for the current gold standard tibial tubercle-trochlear groove (TT-TG) distance. 1,4,6 Therefore, the TT-RA distance is a mixed imaging test.We do agree with Dr Nizic ´that a test of tibial tuberosity lateralization that is independent of femorotibial rotation may be a more reliable assessment.…”

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confidence: 71%

“…4 We found that the value of TT-RA distance is affected by the rotation or flexion of the knee joint, which is also the case for the current gold standard tibial tubercle-trochlear groove (TT-TG) distance. 1,4,6 Therefore, the TT-RA distance is a mixed imaging test.We do agree with Dr Nizic ´that a test of tibial tuberosity lateralization that is independent of femorotibial rotation may be a more reliable assessment. Some measurements such as tibial tuberosity-tibial intercondylar midpoint (TT-TIM) distance, 2 or tibial tubercle-posterior cruciate ligament (TT-PCL) distance 3 can evaluate pure tibial tubercle lateralization.…”

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Pure and Mixed Imaging Tests, Precision, and Sex Dependence in Patellofemoral Imaging: Response

Zhao

Song

et al. 2023

Orthopaedic Journal of Sports Medicine

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We thank Dr Nizic ´for his interest for our recently published study. 6 The tibial tubercle-Roman arch (TT-RA) distance has landmarks on the tibia and femur. Therefore, the translation of the tibia or the rotation of knee joints would alter the value of TT-RA distance. We have also performed studies to investigate the difference in the TT-RA distance between CT and MRI. 4 We found that the value of TT-RA distance is affected by the rotation or flexion of the knee joint, which is also the case for the current gold standard tibial tubercle-trochlear groove (TT-TG) distance. 1,4,6 Therefore, the TT-RA distance is a mixed imaging test.We do agree with Dr Nizic ´that a test of tibial tuberosity lateralization that is independent of femorotibial rotation may be a more reliable assessment. Some measurements such as tibial tuberosity-tibial intercondylar midpoint (TT-TIM) distance, 2 or tibial tubercle-posterior cruciate ligament (TT-PCL) distance 3 can evaluate pure tibial tubercle lateralization. However, the clinical value of these measurements remains uncertain. TT-PCL distance reflects the true lateralization of the tibial tubercle, and the TT-TG distance reflects the mixed tibial tubercle lateralization. We compared the clinical application value between TT-TG and TT-PCL distance in our previously published study and found the difference in the TT-PCL distance between patients with patellar dislocation and healthy controls to be only 1.11 mm. 5 In addition, the TT-PCL distance was found to have a poor capacity to predict patellar dislocation (area under the receiver operating curve [AUC] ¼ 0.627). Therefore, the role of true tibial tubercle lateralization in the evaluation of patellar dislocation patients warrants further assessment. As mixed imaging tests, the TT-RA distance (AUC ¼ 0.8) and TT-TG distance (AUC ¼ 0.8) had higher capacity than TT-PCL distance (AUC ¼ 0.6) to distinguish patients with patellar dislocation from healthy individuals, 5,6 which indicate that the mixed imaging tests would be more suitable to evaluate patellar dislocation.As for the question of the accuracy of the TT-RA distance. We used the intraclass correlation coefficient to evaluate the precision of the measurements, and found that the TT-RA distance showed higher inter-and intraobserver reliability than the TT-TG distance (Table 2 of our study 6 ), especially in patients with patellar dislocation (Figure 6 of our study 6 ). When regarding the precision of TT-RA distance to distinguish patellar dislocation patients from healthy individuals, the AUC was comparable to that of the TT-TG distance (Figure 8 of our study 6 ).The sex difference of TT-RA distance was not investigated in the present study. It is hard to determine any sex-based differences in the TT-RA distance with a small sample size.Thank you for your kind thoughts and interest.

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Pure and Mixed Imaging Tests, Precision, and Sex Dependence in Patellofemoral Imaging: Response

Zhao

Song

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…The TT‐TG were routinely measured on MRI with a value greater than 20 mm used as an indication for surgical correction. Using MRI to calculate the TT‐TG was preferred as this avoids unnecessary radiation associated with CT and has been validated [31, 32]. The Oswestry Patellar Trochlear Algorithm (OPTA) (Fig.…”

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confidence: 99%

Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index

Sharma

Al-Mouazzen

Kuiper

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeMedial patellofemoral ligament reconstruction (MPFL‐R) is a recognised surgical procedure for the treatment of recurrent patellofemoral instability with excellent outcomes reported. The aim of this study is to determine if body mass index can influence these outcomes. MethodsThis is a single‐centre retrospective analysis of a longitudinal patellofemoral database. Patients with recurrent patellar instability, without patellar alta or severe trochlear dysplasia were treated using a MPFL‐R between 2015 and 2019 at The Robert Jones & Agnes Hunt Orthopaedic Hospital. The clinical efficacy following surgery was assessed by Kujula, International Knee Documentation Committee Score (IKDC), and EuroQol‐5 score (EQ‐5D) at baseline and up to 26 months post‐operatively; their safety assessed by complication rate and requirement for further surgery. The effect of Body Mass Index (BMI) on clinical outcome was analysed using linear, curvilinear, and segmented models following propensity score weighting. ResultsA total of 97 patients (97 Knees, mean age 25y) were analysed. Of these, 61 patients had a BMI < 30 kg/m2 (mean age 23y, mean BMI 24) of which 7 patients (12.3%) required additional surgery. A further 36 patients had a BMI > 30 kg/m2 (mean age 27y, mean BMI 36) of which 2 patients (5.6%) required additional surgery. The re‐dislocation rate was 0% in each BMI group. Both groups had a significantly improved mean outcome following surgery, with improvements in mean IKDC above the minimum clinical important differences (MCID) of 20.5. BMI had an inverted J‐shaped association with functional outcome, showing peak outcomes at BMI of 20.5 (95% CI 18.5 to 22.4; IKDC and Kujala) or BMI of 28 (EQ‐5D index). No evidence for an association between BMI and complication risk was found. ConclusionBMI influences the functional outcomes in MPFL‐R with an inverted J‐shaped relation, without evidence it affected the complication or re‐dislocation rate. In the absence of patella alta and severe trochlear dysplasia, an isolated MPFL reconstruction is a safe and effective procedure to treat patellar instability, with the best functional outcome in patients with a BMI around 20 to 21. Level of evidenceLevel III.

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“…As the TT‐PCL distance references two points both on the tibia, it can purely describe the lateralization of the tibial tubercle and will not be influenced by trochlear dysplasia and varying degrees of knee flexion 1,8–15 . Since Seitlinger et al 8 proposed the concept of the TT‐PCL distance, many studies have compared the TT‐PCL distance with the TT‐TG distance 9,10,14,16–20 . While TT‐TG has been shown to have better reliability and diagnostic accuracy in some studies, 10,13,17,21 other studies have suggested that TT‐PCL provides a more accurate measure of true lateralization of the TT.…”

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confidence: 99%

Tibial Tubercle‐Trochlear Groove Distance Has Better Diagnostic Reliability Than Tubercle‐Posterior Cruciate Ligament Distance For Predicting Patellar Instability: A Systematic Review

Zhang

Tian

et al. 2023

Orthopaedic Surgery

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ObjectiveThe tibial tubercle‐trochlear groove (TT‐TG) distance is now routinely utilized to help determine whether a realignment procedure is necessary for patients with patellar instability. The tibial tubercle‐posterior cruciate ligament (TT‐PCL) distance has been explored as an alternative measurement. The aim of this study is to compare the reliability of TT‐TG and TT‐PCL; to explore whether there is a relationship between the TT‐PCL and the TT‐TG distance; to determine whether there is a relationship between the TT‐TG and TT‐PCL distances and knee rotation; and to compare the abilities of the TT‐PCL distance and the TT‐TG distance with predicted patellar instability.MethodThis systematic review was performed in accordance with PRISMA guidelines. Three databases, PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, were searched from inception to September 2021 to identify clinical studies comparing TT‐TG and TT‐PCL distances to patellar instability. Data on patient baseline characteristics, TT‐TG and TT‐PCL distances, inter‐observer reliability, and area under the receiver‐operating characteristic curve (AUC) were recorded. The methodological quality of the studies was assessed using the quality assessment form recommended by the Agency for Healthcare Research and Quality (AHRQ).ResultTwenty studies were included in the final analysis, comprising 2330 knees from 2260 patients. The current study showed that TT‐TG and TT‐PCL have similar observer reliability. The inter‐ and intra‐observer reliability of TT‐TG ranged from 0.807 to 0.98 and 0.553 to 0.99, respectively. The inter‐ and intra‐observer reliability of TT‐PCL ranged from 0.553 to 0.99 and 0.88 to 0.981, respectively. Six studies compared the AUC for predicting patellar instability and showed that TT‐TG had better predictive performance than TT‐PCL. Three studies reported a correlation between TT‐TG and knee rotation, but no such relationship was found for TT‐PCL. Eight studies reported a weak or moderate correlation between TT‐TG and TT‐PCL.ConclusionTT‐TG and TT‐PCL have similar inter‐ and intra‐rater reliability (as measured by ICC), but TT‐TG has greater discriminatory power to predict patellar instability than TT‐PCL (as measured by AUC values and odds ratio). However, considering trochlear dysplasia and individual variations, future studies need to find more accurate and individualized methods to predict patellar instability.

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CT and MRI measurements of tibial tubercle lateralization in patients with patellar dislocation were not equivalent but could be interchangeable

Cited by 7 publications

References 26 publications

Pure and Mixed Imaging Tests, Precision, and Sex Dependence in Patellofemoral Imaging: Response

Pure and Mixed Imaging Tests, Precision, and Sex Dependence in Patellofemoral Imaging: Response

Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index

Tibial Tubercle‐Trochlear Groove Distance Has Better Diagnostic Reliability Than Tubercle‐Posterior Cruciate Ligament Distance For Predicting Patellar Instability: A Systematic Review

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