Evaluation of the Tibial Tubercle to Posterior Cruciate Ligament Distance in a Pediatric Patient Population

Clifton, Blake C; Richter, Dustin L.; Tandberg, Dan; Ferguson, Matthew; Treme, Gehron

doi:10.1097/bpo.0000000000001035

Cited by 17 publications

(14 citation statements)

References 24 publications

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“…The normal range of values for TT-PCL has been reported as 11.9 ± 4.67 mm, with a value more than 20 mm considered pathologic [10,22]. A pediatric cohort exhibited similar anatomy: mean TT-PCL was 20.1 mm [23]. Interestingly, in the pediatric study, when a group with patellofemoral instability was compared to a group without instability, the TT-PCL value was not found to differ significantly (average 19.9 mm) for the control group.…”

Section: Tt-pcl: Normal and Pathologic Valuesmentioning

confidence: 99%

Use of TT-PCL versus TT-TG

Brady

Rosencrans

Stein

2018

Curr Rev Musculoskelet Med

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While the TT-TG value may be confounded by several factors, including age, gender, body mass index, and varying degrees of knee flexion on cross-sectional imaging, recent literature supports its utility for differentiation of patients with and without patellofemoral instability, and stratification of patients with and without coronal malalignment. The TT-PCL describes pure lateralization of the tibial tubercle, and may be used in conjunction with the TT-TG to better understand the path taken by the extensor mechanism of the knee joint. The TT-TG measurement is superior to the TT-PCL measurement for differentiating patients with patellofemoral instability from their stable counterparts, though TT-PCL may be useful in conjunction with TT-TG for better understanding the path of the extensor mechanism across the knee joint.

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Section: Tt-pcl: Normal and Pathologic Valuesmentioning

confidence: 99%

Use of TT-PCL versus TT-TG

Brady

Rosencrans

Stein

2018

Curr Rev Musculoskelet Med

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“…29 Several studies have attempted to determine the patients who would benefit from a concomitant TTO based on anatomic patellar instability risk factors, including patella alta, tibial tubercletrochlear groove (TT-TG) or tibial tubercle-posterior cruciate ligament (TT-PCL) distance, trochlear dysplasia, and abnormal lateral patellar tilt. 5,10,19,27 Studies have cited trochlear dysplasia as the main anatomic risk factor for lateral patellar dislocation, followed by lateral patellar tilt (20°). 5,9,26 In regard to TT-TG or TT-PCL distance, however, there have been mixed results, with some authors recommending a concomitant TTO when the TT-TG or TT-PCL distance is .20 mm or .24 mm, respectively, while others report that the normal TT-PCL distance of patients without instability is 19.9 mm.…”

mentioning

confidence: 99%

“…5,9,26 In regard to TT-TG or TT-PCL distance, however, there have been mixed results, with some authors recommending a concomitant TTO when the TT-TG or TT-PCL distance is .20 mm or .24 mm, respectively, while others report that the normal TT-PCL distance of patients without instability is 19.9 mm. 9,10,27 Hence, patients with patellar instability may benefit from an isolated MPFL reconstruction regardless of bony anatomy.…”

mentioning

confidence: 99%

Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years

et al. 2019

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Background: It is unclear which patients with recurrent patellar instability require a bony procedure in addition to medial patellofemoral ligament (MPFL) reconstruction. Purpose: To report 1- and 2-year outcomes of patients after isolated MPFL reconstruction performed for patellar instability regardless of patellar height, tibial tubercle–trochlear groove (TT-TG) distance, or trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects (Outerbridge grade IV), cartilage defects (especially inferior/lateral patella), previous failed surgery, or pain >50% as their chief complaint were prospectively enrolled beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Information on recurrent subjective instability, dislocations, ability to return to sport (RTS), and outcome scores was recorded at 1 and 2 years. TT-TG distance, patellar height (with the Caton-Deschamps index), and trochlear depth were measured. Results: Ninety patients (77% female; mean ± SD age, 19.4 ± 5.6 years) underwent MPFL reconstruction between March 2014 and August 2017: 72 (80%) reached 1-year follow-up, and 47 (52.2%) reached 2-year follow-up (mean follow-up, 2.2 years). Mean TT-TG distance was 14.7 ± 5.4 mm (range, –2.2 to 26.8 mm); mean patellar height, 1.2 ± 0.11 mm (range, 0.89-1.45 mm); and mean trochlear depth, 1.8 ± 1.4 mm (range, 0.05-6.85 mm). Ninety-six percent of patients at 1 year and 100% at 2 years had no self-reported patellofemoral instability; 1 patient experienced a redislocation at 3.5 years. RTS rates at 1 and 2 years were 90% and 88%, respectively. Mean time to RTS was 8.8 months. All patients had clinically and statistically significant improvement in mean Knee injury and Osteoarthritis Outcome Score–Quality of Life (32.7 to 72.0, P < .001), mean International Knee Documentation Committee subjective form (51.4 to 82.6, P < .001), and mean Kujala score (62.2 to 89.5, P < .001). No difference existed between 1- and 2-year outcome scores (all P > .05). Conclusion: At early follow-up of 1 and 2 years, isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in outcome scores with a low redislocation/instability rate regardless of bony pathologies, including TT-TG distance, Caton-Deschamps index, and trochlear dysplasia. Future data from this cohort will be used to assess long-term outcomes.

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“…[5,6] Many have strived to bring to light those patients who would profit the most from a concomitant TTO on the basis of anatomic risk factors, such as trochlear dysplasia, TT-TG distance, TT-posterior cruciate ligament (TT-PCL) distance, patella alta, and patellar tilt. [7,8] Among these, the chief anatomic predisposing factor is trochlear dysplasia, succeeded by lateral patellar tilt of >20°. [7,9] With respect to TT-TG and TT-PCL distance, there are multiple studies advising a concomitant TTO when the distance is >20 mm and >24 mm, respectively.…”

Section: Journal Of Arthroscopic Surgery and Sports Medicinementioning

confidence: 99%

Isolated MPFL reconstruction for recurrent lateral patellar instability in patients with TT-TG distance <25 mm: A calculated safe risk!

Verghese

Sahanand

Martin³

et al. 2021

JASSM

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Objectives: The objectives of the study were to describe the surgical technique of our modification of isolated medial patellofemoral ligament (MPFL) reconstruction, in patients with patellar instability. As per literature, isolated MPFL reconstruction is advocated if tibial tubercle-trochlear groove (TTTG) <20 mm. Our study proposes isolated MPFL reconstruction in patients with TT-TG <25 mm and aims to determine any predisposing anatomic variants to aid in the treatment algorithm. Materials and Methods: A retrospective analysis of 52 patients with patellar instability (TT-TG <25 mm), who underwent isolated MPFL reconstruction was undertaken. The study population was divided into two groups; TT-TG <20 mm and TT-TG = 20–24 mm. Both groups were assessed radiologically and on the basis of clinical and functional outcome (KUJALA score), over 5-year follow-up period. Results: The mean age of the study population was 21.98 years, with a female (63.5%) majority. Among the 52 patients included in the study, 39 patients (75%) had TT-TG <20 mm and 13 patients (25%) had TT-TG = 20–24 mm. We noticed statistically significant improvement in both groups with respect to clinical and functional outcome, with no reported complications. None of the patients had patella alta or high grades of trochlear dysplasia. Conclusion: MPFL reconstruction without concomitant bony procedures can be safely performed in patients with a TT-TG <25 mm, in the absence of patella alta or high-grade trochlear dysplasia. Our modification of isolated MPFL reconstruction has shown excellent long-term results. In addition, our technique uses only a single interference screw, thereby reducing cost of surgery and implant hardware.

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Evaluation of the Tibial Tubercle to Posterior Cruciate Ligament Distance in a Pediatric Patient Population

Abstract: Level III-diagnostic.

Cited by 17 publications

References 24 publications

Use of TT-PCL versus TT-TG

Use of TT-PCL versus TT-TG

Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years

Isolated MPFL reconstruction for recurrent lateral patellar instability in patients with TT-TG distance <25 mm: A calculated safe risk!

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