The Tibial Tubercle–to–Trochlear Groove (TT-TG) Distance Is Reliable in the Setting of Trochlear Dysplasia, and Superior to the Tibial Tubercle–to–Posterior Cruciate Ligament (TT-PCL) Distance When Evaluating Coronal Malalignment in Patellofemoral Instability

Brady, Jacqueline M.; Sullivan, Jaron P.; Nguyen, Joseph; Mintz, Douglas N.; Green, Daniel W.; Strickland, Sabrina M.; Stein, Beth E. Shubin

doi:10.1016/j.arthro.2017.06.020

Cited by 42 publications

(80 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using the posterior condyles for reference is in line with accepted measurement techniques for femoral anteversion and the tibial tubercle-trochlear groove distance. 4,24 The LTI has been used previously to study trochlear dysplasia in the setting of PI. 6,27,31 Because the LTI is an MRI measurement, it better characterizes the proximal trochlea, which is an area difficult to appreciate on conventional radiographs as is attempted using the Dejour radiographic classification.…”

mentioning

confidence: 99%

Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia

Joseph

Cheng

Solomito

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Trochlear dysplasia (TD) is a risk factor for patellar instability (PI). The Dejour classification categorizes TD but has suboptimal reliability. Lateral trochlear inclination (LTI) is a quantitative measurement of trochlear dysplasia on a single axial magnetic resonance imaging (MRI) scan. Hypothesis: A modified LTI measurement technique using 2 different axial MRI scans that reference the most proximal aspect of the trochlear cartilage on 1 image and the fully formed posterior condyles on the second image would be as reliable as and significantly different from the single-image measurement technique for LTI. Further, the 2-image LTI would adequately represent overall proximal trochlear morphologic characteristics. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients aged 9 to 18 years treated for PI between 2014 and 2017 were identified. The Dejour classification was radiographically determined. Single-image LTI was measured on a single axial MRI scan at the most proximal aspect of visible trochlear cartilage. A 2-image LTI was measured from 2 separate MRI scans: 1 at the most proximal aspect of trochlear cartilage and the second at the fully formed posterior condyles. This 2-image LTI was repeated at 3 subsequent levels (the first measurement is referred to as LTI-1; repeated measurements are LTI-2, LTI-3, and LTI-4, moving distally). In total, 65 patients met the inclusion criteria, and 30 were randomly selected for reliability analysis. Results: Inter- and intrarater reliability trended toward more variability for single-image LTI (intraclass correlation coefficient [ICC], 0.86 and 0.88, respectively) than for 2-image LTI (ICC, 0.97 and 0.96, respectively). The Dejour classification had lower intra- and interrater reliability (ICC, 0.31 and 0.73, respectively). Average single-image LTI (9.2° ± 12.6°) was greater than average 2-image LTI-1 (4.2° SD ± 11.9°) ( P = .0125). Single-image LTI classified 60% of patients with PI as having TD, whereas the 2-image LTI classified 71% as having TD. The 2-image LTI was able to capture 91% of overall proximal trochlear morphologic characteristics. Conclusion: LTI has higher reliability when performed using a 2-image measurement technique compared with single-image LTI and Dejour classification. The strong correlation between 2-image LTI and average LTI shows that 91% of TD is represented on the most proximal axial image. Because the single-image measurement appears to underestimate dysplasia, previously described thresholds should be reexamined using this 2-image technique to appropriately characterize TD.

show abstract

mentioning

confidence: 99%

Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia

Joseph

Cheng

Solomito

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Interclass reliability was moderately high for TT-PCL distance measurement (interclass correlation coefficient ¼ 0.625), but it did not predict membership in the patellar instability subgroup as effectively as TT-TG measurement. 1 Both measurements maintained their reliability in the setting of trochlear dysplasia. The authors found that reliability was low for agreement with the Dejour classification of trochlear dysplasia.…”

Section: See Related Article On Page 2026mentioning

confidence: 82%

“…The authors found that reliability was low for agreement with the Dejour classification of trochlear dysplasia. 1 Coronal plane malalignment caused by lateralized tibial tuberosity has been shown to correlate with the increased lateral shift and tilt of the patella among patients with patellar instability. 2 Reducing lateralization with a medializing tibial tuberosity osteotomy (TTO) decreases the shift and tilt.…”

Section: See Related Article On Page 2026mentioning

confidence: 99%

Editorial Commentary: Measuring Coronal (Mal)Alignment for Patients With Patellar Instability: Tibial Tubercle–to–Trochlear Groove Versus Tibial Tubercle–to–Posterior Cruciate Ligament Distance

Cosgarea

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

“…The pathological threshold value of TT-TG is 20 mm and of the TT-PCL is 24 mm. 24,[33][34][35] Some studies suggest relocating the tibial tuberosity at this threshold. 25,26 In this study, we found a slight tendency that a TT-TG >20 mm could reduce functional outcome (Tegner score) after isolated MPFL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…We determined patellar height according to Caton-Deschamps, 21 trochlear dysplasia according to Dejour et al, 22,23 and the leg axis. Using MRI, the trochlear dysplasia was finally verified, 23 tibial tubercle (TT)-trochlear groove (TG) and TT-posterior cruciate ligament (PCL) distance, 24 cartilage and ligament conditions were evaluated. The patients were examined arthroscopically and subsequently treated with MPFL reconstruction using a gracilis tendon autograft according to the technique developed by Schöttle et al 11 The femoral point of insertion near the adductor tubercle was determined during surgery using an image converter and corresponding radiographic landmarks to avoid technical failure.…”

Section: Methodsmentioning

confidence: 99%

Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors

Blanke¹,

Watermann

Haenle³

et al. 2019

J Knee Surg

View full text Add to dashboard Cite

Patellofemoral instability is a severe problem in young and active patients. This pathology is influenced by ligamentous, bony, and neuromuscular parameters. The reconstruction of the medial patellofemoral ligament (MPFL) evolved to a primary procedure, but combined procedures were more frequently performed in the past years. However, additional operative procedures are associated with increased morbidity and no absolute indication can be identified in the literature. This study is intended to clarify whether addressing only ligamentous influence factors (MPFL) in chronic patellofemoral instability is sufficient to produce good clinical outcomes, or whether other risk factors influence the results negatively and should also be treated at some point. In 52 patients with chronic patellofemoral instability patellar height according to Caton-Deschamps, trochlear dysplasia according to Dejour, the leg axis, the femoral antetorsion, tibial tubercle (TT)–trochlear groove, and TT–posterior cruciate ligament distance were evaluated. All patients were treated with isolated MPFL reconstruction. After a minimum follow-up period of 24 months (24–36 months), the clinical outcome results were calculated using the scoring system according to Lysholm and Tegner. Correlation between clinical outcome scores and anatomic risk factors were calculated. The analysis was performed using a standard statistical software package (JMP version 12, SAS Institute, Cary, NC). The average postoperative Lysholm score increased significantly from 57.23 ± 19.9 to 85.9 ± 17.2 points (p < 0.0001) after isolated MPFL reconstruction. Moreover, the Tegner and Lysholm scores significantly improved both in patients without and with different risk factors postoperative. There were no significant differences in the outcome sores between the groups. Even the degree of trochlear dysplasia (types I–III) did not influence the results. Finally, there was no significant correlation found between all collected risk factors and the postoperative outcome scores. Isolated MPFL reconstruction can be an effective procedure in patients with patellofemoral instability and mild to moderate risk factors.

show abstract

The Tibial Tubercle–to–Trochlear Groove (TT-TG) Distance Is Reliable in the Setting of Trochlear Dysplasia, and Superior to the Tibial Tubercle–to–Posterior Cruciate Ligament (TT-PCL) Distance When Evaluating Coronal Malalignment in Patellofemoral Instability

Cited by 42 publications

References 22 publications

Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia

Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia

Editorial Commentary: Measuring Coronal (Mal)Alignment for Patients With Patellar Instability: Tibial Tubercle–to–Trochlear Groove Versus Tibial Tubercle–to–Posterior Cruciate Ligament Distance

Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors

Contact Info

Product

Resources

About