The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic, Peter; Runer, Armin; Dirisamer, Florian; Balcarek, Peter; Giesinger, Johannes; Biedermann, R.; Liebensteiner, Michael

doi:10.1007/s00264-017-3531-1

Cited by 20 publications

(17 citation statements)

References 16 publications

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“…Graf et al reported the inaccuracy of surgical intervention and demonstrated the need for combining the TSA and TT-TG distances to avoid overcorrection during medial tibial tubercle osteotomy [ 25 ]. Our results reported that the TT-TG distance had a positive correlation with height and knee size, which was comparable to other studies [ 28 , 53 , 54 ]. Moreover, several studies have described that the application of TT-TG indices (the ratio of the TT-TG distance to the tibial maximal mediolateral axis) obtained more reliable and standardized results, but the results needed to be further confirmed [ 27 , 54 ].…”

Section: Discussionsupporting

confidence: 93%

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

Liu

Tian

et al. 2021

BMC Musculoskelet Disord

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Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately.

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Section: Discussionsupporting

confidence: 93%

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

Liu

Tian

et al. 2021

BMC Musculoskelet Disord

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“…Our result reported that the TT-TG distance had a positive correlation with height and the knee size, which was comparable to other literatures [11,16,23]. Moreover, several literatures described that application of the TT-TG indices (ratio of the TT-TG distance to the tibial maximal mediolateral axis) obtained more reliable and standardized results [7,16]. Hernigou et al used fML and tML to establish normal values of TT-TG distances in Greek.…”

Section: Discussionsupporting

confidence: 89%

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Li¹,

Liu²,

Tian³

et al. 2020

Preprint

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Our objective was to obtain normal patellofemoral measurements so as to provide a reference for prosthetic design. Besides, the absolute values and indices of TT-TG distances are still controversial in clinical application. A better method to enable precise clinical applications is still needed.Methods:78 knees of 78 subjects without knee pathologies were included in this cross-sectional study. A CT scan was obtained from all subjects and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analyzed 19 parameters including TT-TG distance and dimensions and shapes of patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances.Results:The dimensional indexes, TT-TG distance, and femoral aspect ratio of the males were significantly larger than those of females (all P values <0.05). However, after controlling the bias from age, height, and weight, there were no significant differences in TT-TG distances, PAL, and anterior-posterior dimensions between genders (all P values >0.05). The Pearson correlation coefficients between the AFO and other indexes were consistently below 0.3, indicating a none or weak relationship. Similar results were observed for the SA and the Wiberg index. Using LASSO regression, we obtained four parameters to predict TT-TG distance (R2=0.5612, P<0.01) to achieve the optimal accuracy and convenience. Conclusion:The anterior-posterior dimensions of the females were thicker than those of males for the same medial-lateral dimensions. More attention should be paid to not only gender differences but individual differences, especially the anterior condyle and trochlea. Besides, this study provided a new method of predicting TT-TG distance to enable precise clinical diagnoses and guide the medial transfer of the tibial tuberosity.

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“…[7][8][9][10]12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] These included five publications that compared between TT-TG distances measured using CT and MRI, [7][8][9][10]12 and 21 publications that compared between TT-TG distances for patients with and without patellofemoral instability. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Collectively, these included a total of 3,040 patients. The details of the study design and patient population of all the studies are reported in ►Tables 1 and 2.…”

Section: Resultsmentioning

confidence: 99%

“…4). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Pooling of all the patients from these 18 studies then revealed that the mean TT-TG distance for the control group was 12.85 mm (95% CI: 11.71-14.01), while the mean TT-TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04-19.62) when measured on CT. When measured on MRI, the mean TT-TG distance for the control group was 9.83 (95% CI: 9.11-10.54) while the mean TT-TG distance for patients with patellofemoral instability was 15.33 (95% CI: 14.…”

Section: Discussionmentioning

confidence: 99%

The Difference between Computed Tomography and Magnetic Resonance Imaging Measurements of Tibial Tubercle–Trochlear Groove Distance for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-analysis

et al. 2019

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AbstractThe tibial tubercle–trochlear groove (TT–TG) distance was originally described for computed tomography (CT) but has recently been used on magnetic resonance imaging (MRI) without sufficient evidence demonstrating its validity on MRI. The current review aims to evaluate (1) whether there is a difference in the TT–TG distances measured using CT and MRI, (2) whether both the TT–TG distances measured using CT and MRI could be used to differentiate between patients with or without patellofemoral instability, and (3) whether the same threshold of 15 to 20 mm can be applied for both TT–TG distances measured using CT and MRI. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that compared TT–TG distances either (1) between CT and MRI or (2) between patients with and without patellofemoral instability were included. A total of 23 publications were included in the review. These included a total of 3,040 patients. All publications reported the TT–TG distance to be greater in patients with patellofemoral instability as compared to those without patellofemoral instability. This difference was noted for both TT–TG distances measured on CT and on MRI. All publications also reported the TT–TG distance measured on CT to be greater than that measured on MRI (mean difference [MD] = 1.79 mm; 95% confidence interval [CI]: 0.91–2.68). Pooling of the studies revealed that the mean TT–TG distance for the control group was 12.85 mm (95% CI: 11.71–14.01) while the mean TT–TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04–19.62) when measured on CT. When measured on MRI, the mean TT–TG distance for the control group was 9.83 mm (95% CI: 9.11–10.54), while the mean TT–TG distance for patients with patellofemoral instability was 15.33 mm (95% CI: 14.24–16.42). Both the TTTG distances measured on CT and MRI could be used to differentiate between patients with and without patellofemoral instability. Patients with patellofemoral instability had significantly greater TT–TG distances than those without. However, the TT–TG distances measured on CT were significantly greater than that measured on MRI. Different cut-off values should, therefore, be used for TT–TG distances measured on CT and on MRI in the determination of normal versus abnormal values. Pooling of all the patients included in the review then suggest for 15.5 ± 1.5 mm to be used as the cut off for TT–TG distance measured on CT, and for 12.5 ± 2 mm to be used as the cut-off for TT–TG distance measured on MRI. The Level of evidence for this study is IV.

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The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Cited by 20 publications

References 16 publications

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

The Difference between Computed Tomography and Magnetic Resonance Imaging Measurements of Tibial Tubercle–Trochlear Groove Distance for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-analysis

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