The Relationship Between Tibial Tubercle–Trochlear Groove Distance and Noncontact Anterior Cruciate Ligament Injuries in Adolescents and Young Adults

Saper, Michael G.; Popovich, John M.; Fajardo, Ryan S.; Hess, Shane R.; Pascotto, Jeremy L.; Shingles, Michael

doi:10.1016/j.arthro.2015.06.036

Cited by 19 publications

(27 citation statements)

References 21 publications

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“…Given that Pandit and Wittstein performed MRI acquisition with knees in full extension (which leads to an overestimation of the TT-TG) and that the present study protocol was performed with knees in 15°of flexion, it is likely that the mean values in the aforementioned studies would align even closer with the normal range in this study if identical knee protocols were followed. Further, in comparison to the normal range of 10.4 mm (95% CI, 9.64-11.24) reported by Saper, [16] where a 25°of knee flexion protocol was used, the control group in the present study still underestimated this mean by almost 2 mm. Yet when comparing the IKD cruciate injury subgroup (12.2 mm, p < 0.004) in the present study to the ACL deficient group (12.95 mm, p < 0.005) in the Saper study (the primary pathology accounted for in the study), the results closely approximate each other.…”

Section: Discussioncontrasting

confidence: 84%

“…With meniscal tears in their control group, the normal range was overestimated. By accounting for meniscal tears in the present study, the data reveal a greater difference (3.27 mm) between the internally deranged and anatomically intact knees than what was previously reported by Saper et al (1.63 mm) [16]. This difference is both greater and more significant than what was previously reported, therefore supporting the association of increased TT-TG distances with both meniscal and cruciate internal knee derangements.…”

Section: Discussionsupporting

confidence: 72%

“…Given the primary focus on patellar dislocation in previous studies, the control groups have commonly included a variety of other internal knee derangements as long as the clinical history of patellar instability is absent. Cruciate ligament tears, as well as meniscal tears, are often included with internally intact knees to comprise the control TT-TG group [16][17][18][19]. Building on the findings of Saper et al which raised the possibility of an association between internal derangement (other than a patella-femoral dislocation) and increased lateralization of the patella, this practice is being brought into question by the present study [16].…”

Section: Introductionmentioning

confidence: 93%

“…In the context of a patellar dislocation, TT-TG values greater than 15 to 20 mm are widely considered to be abnormal [9][10][11], yet there is a lack of consensus in the literature regarding which TT-TG values fall within the normal range. The normal range has previously been reported to be as low as 8.2 ± 3.7 mm [12] and as high as 13.6 ± 8.8 mm [13] with many studies falling somewhere in the middle [2,[12][13][14][15][16]. Additionally, the aforementioned normal studies have been complicated by inconsistent inclusion and exclusion criteria.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between patellar lateralization diagnostic imaging markers and non-contact internal knee derangements

Stumetz¹,

Gothard

Walser³

et al. 2020

J Orthop Surg Res

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Background: To investigate differences in the tibial tubercle-trochlear groove (TT-TG) and patellar tendon-posterior cruciate ligament (PT-PCL) distances in symptomatic patients with non-contact internal knee derangements (IKD) and symptomatic patients with internally intact knees (control). Methods: A retrospective review of MRI studies was completed by comparing 78 patients with meniscal and ligamentous derangements of the knee to 63 internally intact knees (age range, 13 to 50 years). MRI findings were reviewed independently by two board-certified radiologists to assess for agreement. TT-TG and PT-PCL distances were measured on proton density-weighted axial images by two independent observers blinded to the MRI and arthroscopic findings. Independent t tests were used to determine differences in TT-TG distance between the internal derangement and control groups. Chi-square tests were used to compare categorical variables for distributional equality between study groups. Results: The mean TT-TG distance averaged across the two raters in the IKD group was 11.5 mm (95% confidence interval [CI], 10.6-12.4), compared to 8.3 mm (95% CI, 7.6-9.0) in the control group (p < 0.001). The mean PT-PCL distance similarly averaged across both raters was 20.6 mm (95% CI, 19.7-21.5) for the IKD group compared to 18.2 mm (95% CI, 17.2-19.2) for the control group (p < 0.001). Among the IKD group, there were 51 meniscal tears, 12 cruciate ligament tears, and 15 tears with a combination of meniscal and cruciate findings. IKD was significantly correlated with greater TT-TG distance (p < 0.001) and greater PT-PCL distance (p < 0.003) when compared with control. Conclusions: Increased TT-TG distances and PT-PCL distances are associated with both cartilaginous and ligamentous internal knee injuries in the present study, with TT-TG distances greater than the 12 mm representing a new threshold for concern.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The relationship between patellar lateralization diagnostic imaging markers and non-contact internal knee derangements

Stumetz¹,

Gothard

Walser³

et al. 2020

J Orthop Surg Res

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“…Camp et al 10 and Pandit et al 11 concluded that MRI is highly effective for TTTG measurements. Saper et al 12 analyzed torn ACL and showed endorotation in ACL-deficient knees; Shakespeare and Fick 13 reported malalignment of the patellofemoral joint in ACL-deficient knees. The mean TTTG value before surgery in this study was 13.80 mm.…”

Section: Discussionmentioning

confidence: 99%

Modified exorotation graft tension for tibial fixation in anterior cruciate ligament reconstruction: a randomized controlled trial

et al. 2018

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Background: The inability of anterior cruciate ligament reconstruction (ACLR) surgery to reduce tibial internal rotation causes many problems. A large tibial internal rotation will result in a patellofemoral pain syndrome. This study aimed to introduce a new technique of modified exorotation graft tension at tibial fixation to minimize endorotation, reduce tibial internal rotation, and prevent patellofemoral pain syndrome.Methods: This study was a randomized double-blind controlled clinical trial. ACL rupture patients underwent ACLR surgery between December 2014 and Februrary 2015. They were randomized to standard endorotation group or modified exorotation group. Hamstring autograft was used and fixed with an EndoButton® and bioabsorbable interference screw. Tibial tubercle to trochlear grove (TTTG) was used to evaluate rotation, whereas cartilage oligomeric matrix protein (COMP) was employed to analyze cartilage breakdown. The functional outcome was measured using the Kujala score to assess patellofemoral joint function. Evaluations were conducted before the surgery and at 6 months postoperation.Results: A total of 29 subjects were recruited. Sixteen subjects were allocated into the standard endorotation group, and 13 were assigned to the modified exorotation group. The exorotation group demonstrated better results than the endorotation group in all three parameters: TTTG (p=0.028), COMP (p<0.001), and Kujala score (p=0.015).Conclusion: A new technique of modified exorotation direction of graft tension for ACL reconstructive surgery at tibial fixation showed a significant reduction in tibial internal rotation and cartilage breakdown. The proposed method could significantly improve the functional outcome of those with total ACL rupture.

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Temporal changes in tibiofemoral relationship following anterior cruciate ligament injury: Implications for rotational dynamics and clinical outcomes

Okimura,

Suzuki,

Ikeda

et al. 2024

J. exp. orthop.

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PurposeThis study aims to elucidate changes in the tibiofemoral relationship over time following anterior cruciate ligament (ACL) injury, and investigate the correlation between the tibiofemoral relationship and patient‐related outcome measures (PROMs).MethodsOverall, 203 primary ACL reconstructions were performed using autologous hamstring grafts. Medial and lateral anterior tibial translation (ATT) in the sagittal plane and tibial tubercle‐trochlear groove (TT‐TG) distance in the axial plane were measured using pre‐operative magnetic resonance imaging and post‐operative computed tomography. The difference between pre‐operative and post‐operative values for each parameter was calculated: ΔMesdial ATT, ΔLateral ATT and ΔTT‐TG distance. The correlation between each calculated value and the time elapsed since ACL injury, and the correlation between each calculated value and PROMs—evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS)—were assessed.ResultsSixty‐four patients were enroled. Medial ATT, lateral ATT and TT‐TG distance were significantly different pre‐operatively compared to post‐operative values, with the tibia translating anteriorly and rotating internally relative to the femur. ΔMedial ATT, ΔLateral ATT and ΔTT‐TG distance were 1.6, 8.8 and −4.8 mm, respectively. A negative correlation was observed between the ΔTT‐TG distance and the time elapsed since the injury (r = −0.44, p < 0.01). No correlation was found between ΔMedial ATT and the time elapsed since the injury, nor between ΔLateral ATT and the time elapsed since the injury. Neither the ΔMedial ATT, ΔLateral ATT, nor ΔTT‐TG distance correlated with the pre‐operative or post‐operative KOOS subscale scores.ConclusionsThe tibia underwent internal rotation relative to the femur over time following ACL injury, highlighting the importance of assessing rotational changes in ACL‐injured knees.Level of EvidenceLevel Ⅲ.

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The Relationship Between Tibial Tubercle–Trochlear Groove Distance and Noncontact Anterior Cruciate Ligament Injuries in Adolescents and Young Adults

Cited by 19 publications

References 21 publications

The relationship between patellar lateralization diagnostic imaging markers and non-contact internal knee derangements

The relationship between patellar lateralization diagnostic imaging markers and non-contact internal knee derangements

Modified exorotation graft tension for tibial fixation in anterior cruciate ligament reconstruction: a randomized controlled trial

Temporal changes in tibiofemoral relationship following anterior cruciate ligament injury: Implications for rotational dynamics and clinical outcomes

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