Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population

Dickens, Aaron J.; Morrell, Nathan T.; Doering, Andrew; Tandberg, Dan; Treme, Gehron

doi:10.2106/jbjs.m.00688

Cited by 110 publications

(82 citation statements)

References 13 publications

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“…8 This is the first study to investigate TT-TG in an adolescent PFP cohort with no history of dislocation. The average TT-TG distances for the PFP (12.2mm) and control (10.0mm) cohorts in this study closely matched the average values found in adolescents with patellar instability (12.1mm) 10 and healthy adolescent controls (9.4 mm). 51 The average TT-TG of extreme maltrackers (14.2mm) in the current study exceeded that of adolescent subjects with patellar instability.…”

Section: Discussionsupporting

confidence: 84%

“…In addition, both of these analyses used static imaging techniques and included or focused exclusively on adolescents with PFP secondary to patellar dislocation. Two other studies, 2, 10 also focused on adolescent cohorts with patellar instability, reported higher rates of dislocation in adolescent patients with increased distance between the tibial tuberosity and trochlear groove (TT-TG). Finally, studies 19, 26, 27 have identified increased hip and knee abduction moments as risk factors for the development of PFP in adolescents.…”

Section: Introductionmentioning

confidence: 99%

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Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

2016

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Background Patellofemoral pain is a prevalent disorder among female adolescents. Overuse is frequently cited as the etiology of pain for this population. What is currently unclear, however, is if the patella demonstrates abnormal tracking patterns relative to the femoral trochlear groove in adolescent females with patellofemoral pain. Purpose The aim of this case-control study is to determine if abnormal patellar tracking patterns are present in adolescent females with patellofemoral pain. The secondary aim is to identify if an increased distance between the tibial tuberosity and trochlear groove (TT_TG) is associated with the observed kinematic patterns. Study Design Case Control Methods Twenty female adolescent knees from 12 subjects with patellofemoral pain and 20 age-matched female knees from 13 healthy controls were recruited for this study. Patellofemoral kinematics (e.g., lateral patellar displacement) during a repetitive knee extension-flexion maneuver were quantified from dynamic cine-phase-contrast magnetic resonance imaging techniques. Static magnetic resonance images were used to determine the TT-TG distance. Results Relative to the control cohort, female adolescents with patellofemoral pain demonstrated significantly greater lateral displacement at 10° (3.2mm, p<0.001), 20° (2.3mm, p<0.001), and 30° (1.7mm, p=0.014) of knee flexion. A subgroup within this cohort (7 knees from 5 subjects) demonstrated extreme lateral maltracking >2 standard deviations beyond the average control. This subgroup also demonstrated a greater distance between the tibial tuberosity and trochlear grove relative to controls (Δ=4.2mm, p=0.001). Conclusions This study demonstrates that abnormal patellar tracking patterns are present in adolescent females with patellofemoral pain. Since all subjects from both cohorts participated in impact sports, it appears that rigorous athletic training alone is inadequate to produce symptoms in this population. Rather, patellofemoral pain may derive from a combination of physical activity in the context of pathologic kinematics.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

2016

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“…13 Based on these findings, TT-TG distances ≥15mm and ≥20mm have been proposed as the threshold for pathological categorization on MR and CT images, respectively, for patients with a history of patellar dislocation. 3, 12, 14, 47 The current study supports using these two thresholds for pathological TT-TG distances in managing patients with PFP.…”

Section: Discussionsupporting

confidence: 76%

“…Based on their findings, the authors recommended 9mm as the critical value for diagnosis of TT malalignment. Subsequent studies, 14, 31 including the current study, have shown that the average TT-TG distance for skeletally mature controls (10mm) is higher than the recommended threshold. Thus, the proposed critical value is clearly too low.…”

Section: Discussionmentioning

confidence: 45%

The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

et al. 2017

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Background The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. Purpose To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans. Results The cohort with PFP demonstrated a significantly greater mean TT-TG distance, relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = 0.001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥ 20 mm. Conclusion Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee..

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“…Investigators identified 280 consecutive knee MRI examinations from subjects referred to the medical center imaging department for non-traumatic symptomatic knee pain, between January 1, 2017, and July 15, 2018. The age range of 13-50 years and non-contact mechanism of injury were both required for inclusion in the present study, with 13 years being chosen as the lower limit due to TT-TG measurement stabilization by this age [20]. Two blinded board-certified radiologists then reviewed the MR images of each subject to assess for the presence of meniscal and cruciate tears.…”

Section: Study Populationmentioning

confidence: 99%

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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Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population

Cited by 110 publications

References 13 publications

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

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

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