Patellar Tendon–Trochlear Groove Angle Measurement

Hinckel, Betina B.; Gobbi, Riccardo Gomes; Filho, Eduardo Noda Kihara; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luís

doi:10.1177/2325967115601031

Cited by 40 publications

(27 citation statements)

References 37 publications

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“…The distal patellofemoral alignment is influenced by the localization of the tibial tuberosity. The TT-TG and TT-PCL distances have become the most frequently used parameters to assess the position of the tibial tuberosity as indicators for distal patellofemoral realignment procedures (i.e., tibial tuberosity osteotomy) [ 25 , 41 ]. It has been hypothesized that a lateralized tibial tuberosity may be caused by excessive external tibial torsion [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity

Winkler¹,

Lutz²,

Rupp³

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a segmental analysis of tibial torsion in patients, with normal and increased external tibial torsion, suffering from chronic patellofemoral instability (PFI) and to investigate a possible correlation between tibial torsion and the position of the tibial tuberosity. Methods Patients with chronic PFI who underwent torsional analysis of the lower limb using a standardized hip-knee-ankle MRI between 2016 and 2018 were included. For segmental analysis of tibial torsion, three axial levels were defined which divided the tibia into two segments: a distal, infratuberositary segment and a proximal, supratuberositary segment. Torsion was measured for the entire tibia (total tibial torsion, TTT), the proximal segment (proximal tibial torsion, PTT), and the distal segment (distal tibial torsion, DTT). Based on TTT, patients were assigned to one of two groups: Normal TTT (< 35°) or increased external TTT (> 35°). Position of the tibial tuberosity was assessed on conventional MRI scans by measuring the tibial tuberosity-trochlea groove (TT-TG) and the tibial tuberosity-posterior cruciate ligament (TT-PCL) distances. Results Ninety-one patients (24 ± 6 years; 78% female) were included. Mean external TTT was 29.6° ± 9.1° and 24 patients (26%) had increased external TTT. Compared to patients with normal TTT, patients with increased external TTT demonstrated significantly higher values for DTT (38° ± 8° vs. 52° ± 9°; p < 0.001), whereas no difference was found for PTT ( – 13° ± 6° vs. – 12° ± 6°; n.s.). Furthermore, a significant correlation was found between TTT and DTT (p < 0.001), whereas no correlation was found between TTT and PTT (n.s). With regard to TT-TG and TT-PCL distances, no significant differences were observed between the two groups (TT-TG: 15 ± 6 vs. 14 ± 4 mm, n.s.; TT-PCL: 22 ± 4 vs. 21 ± 5 mm, n.s.) and no correlation was found with TTT, DTT, or PTT (n.s.). Conclusion In patients with chronic PFI, increased external TTT of greater than 35° is an infratuberositary deformity and does not correlate with a lateralized position of the tibial tuberosity. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity

Winkler¹,

Lutz²,

Rupp³

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…TT–TG distance measured on computed tomography images is considered the gold standard for assessing the increased lateral quadriceps vector (Hinckel et al 2015a ). However, it has been proposed that TT–TG can also be reliably determined by magnetic resonance imaging (MRI) using either cartilage or bony landmarks (Schoettle et al 2006 ), but data indicates that normal values of TT-TG obtained with CT scan and MRI are not the same (Hinckel et al 2015b ; Schoettle et al 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of knee flexion and extension on the tibial tuberosity–trochlear groove (TT–TG) distance in adolescents

et al. 2018

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BackgroundMeasurement of the tibial tubercle–trochlear groove (TT–TG) distance is used to assess patellofemoral instability and rotation. Since patellofemoral instability and acute patellar dislocation are common among adolescents, it is important to clarify the relationship between TT–TG distance and various flexion and extension angles in asymptomatic children. The purpose of the present study was to determine how knee flexion and extension influence TT–TG-distance values measured using 3D imaging in an anatomic axial plane among asymptomatic adolescents.MethodsWe performed magnetic resonance imaging (MRI) of 26 knees in 13 adolescents (8 boys and 5 girls) of 11–17 years of age, with no known patellofemoral disorders. Imaging was performed with 3.0 T MRI with the knee at four separate angles of flexion between 0° and 30°. Measurements were made by two independent blinded raters.ResultsThe mean TT–TG distance in millimetres was 11.1–0.29 × the angle in degrees. TT–TG distance decreased with greater flexion, showing a mean decrease of 0.29 mm (SD, 0.04) per degree of increased flexion (p < 0.001). We found significant inter-observer (Pearson’s r = 0.636, p = 0.03) and intra-observer (Pearson’s r = 0.792, p ≤ 0.001) correlations. TT–TG values were not significantly correlated with age, length, weight, or body mass index. The rate of TT–TG change (change between consecutive TT–TG values/change between consecutive angles) was significantly negatively correlated with length (p = 0.014), weight (p = 0.004), and body mass index (p = 0.025).ConclusionsOur data revealed that TT–TG distance assessed in the anatomic axial plane decreased with greater flexion in adolescent. Moreover, this effect of knee angle was stronger in smaller subjects. These findings support the need for a standardized protocol for TT–TG distance measurement in adolescents.

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“…21 Tendon-cartilaginous measurement of PTTG is performed on axial images. 24 A primary line was drawn tangent to cartilage of the posterior medial and lateral condyles and two perpendicular lines were drawn: one at the midpoint of the patellar tendon insertion in the tibial tuberosity, and the other at the deepest point of the trochlear cartilage. The distance between these two lines is the PTTG distance measure.…”

Section: Methodsmentioning

confidence: 99%

Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury

et al. 2020

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To compare in magnetic resonance imaging the anatomical risk factors for anterior cruciate ligament (ACL) injury and patellar dislocation among patients who suffered acute knee injury, 105 patients with acute knee injury resulting in 38 patellar dislocations (patella group), 35 ACL injuries (ACL group), and 32 meniscus or medial collateral ligament injuries (control group) were included. These groups were compared for risk factors for patellar dislocation (patellar height, trochlear dysplasia, and quadriceps angle of action) and for ACL injury (intercondylar width, posterior inclination of tibial plateaus, and depth of the medial plateau). Univariate analysis found statistically significant differences (p < 0.05) between the patella and ACL groups in patellar height (Caton-Deschamps [CD] 1.23 vs. 1.07), trochlear facet asymmetry (55 vs. 68%), PTTG (13.08 vs. 8.01 mm), and the patellar tip and trochlear groove (PTTG) angle (29.5 vs. 13.71 degrees). The patella group also differed from control in medial plateau inclination (4.8 vs. 1.87 degrees), patellar height (CD 1.23 vs 1.08), trochlear facet asymmetry (55 vs. 69%), lateral trochlear inclination (17.11 vs. 20.65 degrees), trochlear depth (4.1 vs. 6.05 mm), PTTG (13.08 vs. 9.85 mm), and the PTTG angle (29.5 vs. 17.88 degrees). The ACL and control groups were similar in all measures. Multivariate analysis found the following significant determinants between the Patella and Control groups: patellar height (CD index, odds ratio [OR]: 80.13, p = 0.015), trochlear anatomy (asymmetry of facets M/L, OR: 1.06, p = 0.031) and quadriceps action angle (PTTG angle, OR: 1.09, p = 0.016); between the ACL and control groups: PTTG angle (OR: 0.936, p = 0.04) and female gender (OR: 3.876, p = 0.032); and between the patella and ACL groups, the CD index (OR: 67.62, p = 0.026), asymmetry of the M/L facets (OR: 1.07, p = 0.011) and PTTG angle (OR: 1.16, p < 0.001). In conclusion, in patients with acute knee injury, the anatomical factors patellar height, trochlear dysplasia, and quadriceps angle of action were related to the occurrence of patellar dislocation. None of the anatomical factors studied was related to the occurrence of anterior cruciate ligament injury.

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Patellar Tendon–Trochlear Groove Angle Measurement

Cited by 40 publications

References 37 publications

Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity

Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity

Effects of knee flexion and extension on the tibial tuberosity–trochlear groove (TT–TG) distance in adolescents

Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury

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