Interobserver Reliability and Change in the Sagittal Tibial Tubercle–Trochlear Groove Distance with Increasing Knee Flexion Angles

MacLean, Ian S.; Southworth, Taylor M.; Dempsey, Ian; Naveen, Neal B.; Huddleston, Hailey P.; Lansdown, Drew A.; Yanke, Adam B.

doi:10.1055/s-0041-1729547

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…The for the diferent values of tibial tubercle lateralization obtained from CT and MRI measurements may be various. Previous studies had emphasized the diference in lexion and extension degree of the knee and the efect of knee joint rotation [1,8,[13][14][15]. When the knee joint moved from extension to lexion, the tibia would rotate internally relative to the femur [1,2,13,15].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies had emphasized the diference in lexion and extension degree of the knee and the efect of knee joint rotation [1,8,[13][14][15]. When the knee joint moved from extension to lexion, the tibia would rotate internally relative to the femur [1,2,13,15]. The usage of the MRI knee coil during the examination would increase the internal rotation of the knee joint, which may result in the medialization of the tibial tubercle and a decrease of TT-TG distance and TT-RA distance [1,15,19].…”

Section: Discussionmentioning

confidence: 99%

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

Song

Deng

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the values and the relationship of tibial tubercle lateralization measurements between computerized tomography (CT) and magnetic resonance imaging (MRI). Methods Sixty patients with patellar dislocation who underwent both CT and MRI of the same knee joint from November 2021 to February 2022 were included in our study. The intraclass correlation coeicient (ICC) and Bland-Altman analysis were performed to evaluate the reliability of tibial tubercle-trochlear groove (TT-TG), tibial tubercle-Roman arch (TT-RA), and tibial tubercle-posterior cruciate ligament (TT-PCL) distance measurements. The values of CT and MRI measurements using the same bony landmarks were compared for the diference. Pearson correlation analysis and linear regression analysis were performed to assess the correlation between CT and MRI measurements. Finally, the estimated values obtained from the regression equation were compared with the actual values obtained from the radiological measurement to evaluate the accuracy of the equations. Results A total of 60 patients with patellar dislocation who underwent both CT and MRI of the same knee joint were included in this study. The included measurements showed excellent agreement with ICCs > 0.9. TT-TG distance measured on CT (19.5 ± 5.1 mm) had a mean of 7.1 mm higher than that on MRI (12.4 ± 4.7 mm) (P < 0.001). The mean value of TT-RA distance was 22.5 ± 3.7 mm on CT and 16.7 ± 4.9 mm on MRI (P < 0.001), showing a mean diference of 5.8 mm. The values of TT-TG distance measured by CT and MRI were signiicantly correlated (R = 0.5, P < 0.001). The values of TT-RA distance between these two modalities showed a better correlation than that of TT-TG distance (R = 0.6, P < 0.001). The interchange values of TT-TG distance and TT-RA distance between CT and MRI can be obtained using regression equations (TT-TG distance: y = 0.6x + 12.3; TT-RA distance: y = 0.5x + 14.4). ConclusionThe values of tibial tubercle lateralization measured by MRI may be underestimated compared with those measured by CT. Although the values measured on CT and MRI are not equivalent, the value in the other modality can be estimated. Therefore, an additional CT scan for tibial tubercle lateralization evaluation may not be necessary. Level of evidence Level II.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Song

Deng

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…All MRI studies were performed using 1.5 T (Tesla) or 3 T MRI scanners with 0 degrees of knee lexion. (22) MRIs were reviewed using the picture archiving and communication system (PACS).…”

Section: The Study Protocol Was Approved By the Shamir Medical Center...mentioning

confidence: 99%

“…[6,8,24,35] The mean reported normal TT-TG distance on MRI ranges from 8-15 mm, relating to the knee lexion or extension degree. [1,22,24,30,32] As higher TT-TG value indicates an increased risk for future recurrent patellar instability, it is widely common to suggest surgical intervention and distal realignment procedures in such cases [11,12,18,20,26].…”

Section: Introductionmentioning

confidence: 99%

Individualized tibial tubercle–trochlear groove distance-to-patellar length ratio (TT–TG/PL) is a more reliable measurement than TT–TG alone for evaluating patellar instability

Essa

Lindner

Khatib

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the intra/inter-rater and diagnostic reliability of the sagittal plane adjusted patellar instability ratios (PIRs) compared to tibial tubercle-trochlear groove (TT-TG) distance alone while employing a matched case-control analysis for age and sex to minimize a potential confounding efect. Methods A retrospective case-control study was performed of all knee MRI studies of patients diagnosed with patellar instability, between 2005 and 2020 at a regional tertiary medical centre. Using a 1:1 case-control matching of sex and age at the time of the diagnosis, one control subject was assigned to each case of patellar instability. Measurements of TT-TG distance, sagittal patellar length (PL), sagittal patellar tendon length (PTL), TT-TG/PL ratio, and TT-TG/PTL ratio were conducted. Two orthopaedic surgery residents and a senior musculoskeletal radiologist were assigned to assess the intraand inter-rater reliability. Inter-class coeicients were calculated (ICC). The receiver operating characteristic (ROC) curve and area under curve (AUC) for each parameter were compared to evaluate for diagnostic reliability. Odds ratios (OR) and their 95% conidence intervals (CI) were calculated and a multivariable logistic regression model was performed to control for possible confounders. ResultsThe study included 324 individuals (162 case-control matched pairs). In terms of intra-and inter-rater reliability, TT-TG/PL and TT-TG/PTL ratios showed an excellent correlation within and between readers (TT-TG/PL; intra-rater ICC 0.94 and inter-rater ICC 0.92, TT-TG/PTL; intra-rater ICC 0.91 and inter-rater ICC 0.88). The ROC curve showed a slightly greater AUC of the TT-TG/PL ratio compared to TT-TG distance alone (0.75 vs 0.73, p < 0.001). When applying the pathologic cutof of TT-TG ≥ 20 mm and TT-TG/PL ≥ 0.5; the calculated odds ratios for the above cutof were as follows; TT-TG distance alone had an OR of 14 (95% CI 1.8-106.5, p = 0.011) and OR for TT-TG/PL ratio was 23 (95% CI 3.1-170.3, p = 0.002). In the multivariable analysis, while controlling for height and weight, only the association between TT-TG/PL ratio and patellar dislocation remained statistically signiicant with an adjusted OR of 2.7 (CI 1.3-5.4, p = 0.006), compared to TTTG distance alone (OR = 1.9, n.s.). Conclusions Patellar instability ratios are signiicantly more reliable compared to TT-TG distance alone for the evaluation of patellar instability. Patellar instability ratios present superior diagnostic reliability, sensitivity and speciicity, and intra\ inter rater reliability. Thus, patellar instability ratios could function as a valuable diagnostic tool for the evaluation of patellar instability. Level of evidence III.

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More negative sagittal tibial tuberosity‐trochlear groove distances are correlated with larger patellofemoral chondral lesion size

Bi,

Triana,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to assess the association between sagittal tibial tuberosity‐trochlear groove (sTT‐TG) distance and patellofemoral chondral lesion size in patients undergoing cartilage restoration procedures.MethodsA retrospective cohort analysis of patients who underwent an osteochondral allograft transplantation or matrix‐induced autologous chondrocyte implantation in the patellofemoral compartment, from 2010 to 2020, were included if they had patellofemoral high‐grade lesions, magnetic resonance imaging (MRI) and minimum 2‐year follow‐up. The preoperative sTT‐TG distance was measured independently on axial T2‐weighted MRI sequences by two authors, each at least two weeks apart. Intraoperative lesion size was reported according to operative report measurements by the attending surgeon. An interclass correlation coefficient (ICC) was calculated to assess intra‐ and inter‐rater reliability, and categorical data analysis and linear regression models were used to assess the relationship between sTT‐TG and lesion size.ResultsA total of 80 patients (50 females) with a mean age of 31.5 ± 10.4 years, body mass index of 27.0 ± 5.9 kg/m2 and follow‐up of 61.5 ± 21.4 months were included. A total of 107 lesions were present: 63 patients with unipolar (patella = 41, trochlea = 22) and 22 with bipolar lesions. The mean MRI defect size was 1.6 ± 1.0 cm2 and the mean intraoperative defect size was 3.8 ± 2.4cm2. Intra‐ (ICC: 0.99,0.98) and inter‐rater reliability (ICC: 0.96) were excellent for both MRI defect size and sTT‐TG measurements. The mean sTT‐TG was −4.8 ± 4.9 mm and was significantly inversely related to MRI defect size (−0.45, p < 0.01), intraoperative patellar lesion size (−0.32, p = 0.01), total lesion area (−0.22, p = 0.04), but not trochlear lesion size (−0.09, p = 0.56). Multivariable regression demonstrated a more negative sTT‐TG remained an independent variable correlated with larger MRI‐measured patellofemoral defect sizes and intraoperative patellar lesions.ConclusionA more negative sTT‐TG was an independent variable correlated with larger patellofemoral lesions in patients undergoing patellofemoral cartilage restoration.Level of EvidenceLevel III, Diagnostic.

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Interobserver Reliability and Change in the Sagittal Tibial Tubercle–Trochlear Groove Distance with Increasing Knee Flexion Angles

Cited by 5 publications

References 38 publications

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

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

Individualized tibial tubercle–trochlear groove distance-to-patellar length ratio (TT–TG/PL) is a more reliable measurement than TT–TG alone for evaluating patellar instability

More negative sagittal tibial tuberosity‐trochlear groove distances are correlated with larger patellofemoral chondral lesion size

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