Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity–trochlear groove distance in patients with higher grades of trochlea dysplasia

Nha, Kyung-Wook; Nam, Young Jun; Shin, Myung Jin; Sun, Seung Deok; Park, Jae Young; Debnath, Rajib; Lee, Byung‐Hoon

doi:10.1016/j.knee.2019.05.001

Cited by 15 publications

(12 citation statements)

References 23 publications

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“…Several studies have established new parameters to predict patellar dislocation but included patients with anterior cruciate ligament tear or without patellofemoral pain as the control group, which may introduce potential bias. 18,23,24 In addition, the measurements in our study were performed simultaneously by a radiologist and an orthopaedic surgeon using standard protocols to increase the reliability of the results. Moreover, our study provided evidence and recommendations for the diagnosis and surgical treatment of patellar dislocation.…”

Section: Discussionmentioning

confidence: 99%

Tibial Tubercle–Roman Arch Distance: A New Measurement of Patellar Dislocation and Indication of Tibial Tubercle Osteotomy

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The surgical indication for tibial tubercle osteotomy (TTO) has been based on a tibial tubercle–trochlear groove (TT-TG) distance of 20 mm or greater in patients with patellar dislocation. However, the measurement of this parameter is less reliable in patients with trochlear dysplasia. Hypothesis: The novel measurement of tibial tubercle–Roman arch (TT-RA) distance would be a reliable parameter for identifying the relative position of the tibial tubercle in patients with patellar dislocation, especially those with trochlear dysplasia. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 56 patients with a diagnosis of patellar dislocation and 60 volunteers (60 knee joints) without a history of lower extremity pain or injury were included in our study. The TT-RA distance, TT-TG distance, and some femoral anatomic parameters were assessed by use of computed tomography. The measurements were performed by a radiologist and an orthopaedic surgeon in a blinded and randomized fashion. The difference in each parameter between the study and control groups was analyzed through use of an unpaired t test. Receiver operating characteristic curve analysis was performed to evaluate the discriminatory capacity of the included parameters. The cutoff values of the included measurements with specificity and sensitivity were calculated. In addition, the TT-TG distance and TT-RA distance were analyzed using the Dejour classification to evaluate the intraclass correlation coefficient (ICC) of each parameter in different types of femoral trochlea. Result: A significant difference for TT-RA distance was found between the study group (23.24 ± 4.41 mm) and control group (19.15 ± 4.24 mm) ( P < .001). The TT-RA distance had an area under the curve of 0.757. At a value greater than 23.74 mm, TT-RA distance had 53.57% sensitivity and 88.33% specificity for patellar dislocation. The ICCs of TT-RA distance measurements were excellent in all Dejour classifications (>0.939), whereas the ICCs of TT-TG distance measurements were relatively lower than the ICCs of TT-RA distance measurements. According to the data from included healthy individuals, the pathological TT-RA distance threshold was 26 mm. Conclusion: Compared with TT-TG distance, the TT-RA distance is a more reliable parameter for identifying the relative position of the tibial tubercle in patients with trochlear dysplasia. For patients with a TT-RA distance greater than 26 mm, surgery should be considered to correct the malposition of the tibial tubercle.

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Section: Discussionmentioning

confidence: 99%

Tibial Tubercle–Roman Arch Distance: A New Measurement of Patellar Dislocation and Indication of Tibial Tubercle Osteotomy

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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“… 5 , 7 , 21 , 31 , 34 However, the measurement of TT-TG distance has poor reproducibility in patients with trochlear dysplasia, especially in high-grade trochlear dysplasia. 6 , 12 , 14 Dejour et al 5 reported that 96% of patients with patellar dislocation had trochlear dysplasia. A recent study showed that the interobserver ICC for TT-TG distance was 0.64 for Dejour type D dysplasia.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 20 , 22 , 25 However, the measurement of this parameter in patients with trochlear dysplasia is less reproducible, especially in patients with high-grade trochlear dysplasia. 6 , 14 , 32 Moreover, the TT-TG distance as measured on computed tomography (CT) scans is not equivalent to that on magnetic resonance imaging (MRI) scans, with a mean difference ranging from 2.2 to 4.16 mm. 1 , 3 , 22 , 23 , 26 In addition, the surgical cutoff value of TT-TG distance measured on MRI scans remains unknown, and the cutoff value may be influenced by patient age and body size.…”

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confidence: 99%

Reliability of the Tibial Tubercle–Roman Arch Distance for Evaluating Tibial Tubercle Malposition and Predicting Patellar Dislocation via Magnetic Resonance Imaging

Zhao

Song

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The tibial tubercle (TT)–trochlear groove (TT-TG) distance has low reproducibility in patients with a dysplastic trochlea, whereas the clinical value of the TT–posterior cruciate ligament (TT-PCL) distance remains controversial. Purposes: To establish a method to assess the position of the TT on magnetic resonance imaging (MRI) scans using the TT–Roman arch (TT-RA) distance, compare this method with the TT-TG and TT-PCL distance, and provide the pathological threshold value of the TT-RA distance in patients with patellar dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The TT-RA distance, TT-TG distance, and TT-PCL distance were measured on MRI scans in 70 patients with a history of patellar dislocation and 70 healthy individuals. Inter- and intraobserver reliability of each measurement parameter were evaluated. The discriminatory capacity and the interrelationship of the 3 measurement parameters were investigated using Pearson correlation and the receiver operating characteristic curve. The pathological threshold values of these measurements were calculated according to the data of healthy individuals. Finally, logistic regression analysis was performed using these values. Results: Patients with patellar dislocation had a greater TT-RA distance compared with healthy individuals (18.05 ± 4.16 vs 13.86 ± 2.90 mm; P < .001). The TT-RA distance had a stronger diagnostic capacity, with an area under the curve of 0.802 compared with 0.625 for TT-PCL distance. Excellent reproducibility was seen for TT-RA distance measurement at any degree of trochlear dysplasia (all intraclass correlation coefficients [ICCs] >0.90). The inter- and intraobserver ICCs of the TT-TG distance measurements were extremely low for Dejour type D dysplasia (ICC, 0.509 and 0.616, respectively). The pathological TT-RA distance threshold was calculated as 19.5 mm. Logistic regression showed that patients with a TT-RA distance >19.5 mm were 11.7 times more likely to sustain patellar dislocation than were those with TT-RA distance less than this value. Conclusion: The TT-RA distance was a more reliable parameter with which to evaluate TT position than was TT-TG distance in patients with trochlear dysplasia. The TT-PCL distance was the least reliable among the 3 parameters studied.

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“…1-A). For severe trochlear dysplasia, 3-dimensional CT imaging was used to help determine the deepest point of the trochlear groove 33 . Tibial tubercle lateralization was assessed as the tibial tubercle lateralized position relative to the proximal tibial condyle 20 (Fig.…”

Section: Measurementsmentioning

confidence: 99%

Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic Patellar Dislocation

Chen

et al. 2021

Journal of Bone and Joint Surgery

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Background:The purposes of the present study were (1) to measure the tibial tuberosity-trochlear groove distance and its components with the knee in extension, (2) to determine their diagnostic performance in distinguishing between patients with and without episodic patellar dislocation, and (3) to investigate the relationship of each component to the total tibial tuberosity-trochlear groove distance. Methods:We retrospectively reviewed computed tomography (CT) images of the knee joint in a group of patients with episodic patellar dislocation and a group of control subjects who were treated for another type of knee disorder in our institution between 2015 and 2021. Tibial tuberosity-trochlear groove distance, tibial tubercle lateralization, trochlear groove medialization, and knee rotation were measured on axial images. Partial correlation analysis of the measured parameters was performed after adjusting for remaining variables. Receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were assessed to assess the diagnostic accuracy. A subgroup analysis based on femoral trochlear dysplasia classification was also performed.Results: After screening of 653 patients (947 knees) in our hospital's patient registry, a total of 521 patients (781 knees) were analyzed, including 541 knees (69.3%) with episodic patellar dislocation and 240 knees (30.7%) without episodic patellar dislocation (control group). The tibial tuberosity-trochlear groove distance demonstrated the best diagnostic performance, with the AUC being significantly better than that for other parameters (p < 0.001). The tibial tuberosity-trochlear groove distance was moderately to strongly correlated with knee rotation and trochlear groove medialization in the control and episodic patellar dislocation groups (p < 0.001). However, tibial tubercle lateralization showed a weak correlation with the tibial tuberosity-trochlear groove distance in the control group and moderate correlation in the episodic patellar dislocation group (p < 0.001). Knees with a type-D femoral trochlea had a significantly greater tibial tuberosity-trochlear groove distance than those with a type-A, B, or C femoral trochlea (p £ 0.011).Conclusions: Tibial tuberosity-trochlear groove distance, a reliable predictor of episodic patellar dislocation, was affected more by knee rotation and trochlear groove medialization and was less affected by tibial tubercle lateralization, and it increased with an increasing grade of femoral trochlear dysplasia. The correlation of the tibial tuberosity-trochlear groove distance and its components as noted in the current study will help to achieve a better understanding of the tibial tuberosity-trochlear groove distance.

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Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity–trochlear groove distance in patients with higher grades of trochlea dysplasia

Cited by 15 publications

References 23 publications

Tibial Tubercle–Roman Arch Distance: A New Measurement of Patellar Dislocation and Indication of Tibial Tubercle Osteotomy

Tibial Tubercle–Roman Arch Distance: A New Measurement of Patellar Dislocation and Indication of Tibial Tubercle Osteotomy

Reliability of the Tibial Tubercle–Roman Arch Distance for Evaluating Tibial Tubercle Malposition and Predicting Patellar Dislocation via Magnetic Resonance Imaging

Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic Patellar Dislocation

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