Tibial tubercle–trochlear groove (TT–TG) distance is a reliable measurement of increased rotational laxity in the knee with an anterior cruciate ligament injury

Polat, Ayşe Esin; Polat, Barış; Gürpınar, Tahsin; Sarı, Enes; Çarkçı, Engin; Erler, Kaan

doi:10.1016/j.knee.2020.08.014

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…These data have to be scrutinized further, as the reported differences are very small and may be difficult to interprete. 32 Similarly, Polat et al 31 have reported an increased TT-TG distance in patients with ACL injuries, particularly in those with a concomitant ALL injury. On the basis of their findings, the authors concluded that the TT-TG distance may be a reliable tool to detect increased rotational laxity after an ACL injury.…”

Section: Discussionmentioning

confidence: 92%

“…On the basis of their findings, the authors concluded that the TT-TG distance may be a reliable tool to detect increased rotational laxity after an ACL injury. 31 The TT-TG distance has also been compared before and after ACLR. 21 ACLR was able to reduce large TT-TG distances observed preoperatively, achieving similar values as uninjured controls when double-bundle reconstruction was performed.…”

Section: Discussionmentioning

confidence: 99%

“…While concepts such as internal tibial rotation 45,49 and tibial tubercle–trochlear groove (TT-TG) distance 21,31,36 have become commonplace in the evaluation of patellofemoral instability, 20 these same measures are not typically considered in ACL injuries. Nevertheless, radiographic measurements of axial rotation may play a role in ACL injuries and reinjuries after ACLR.…”

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confidence: 99%

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Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

et al. 2023

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Background: Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined. Purpose: To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity. Results: The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group ( P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° ( P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° ( P < .001). Conclusion: An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

et al. 2023

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“…Several studies have shown that morphometric features of the knee may predispose to ACL injury. [7][8][9][10][11][12][13][14][15][16] Recent findings have indicated that the combination of morphometric features may be utilized in further elucidating the mechanism of ACL injury. [26] Bayer et al [27] reported that intercondylar notch stenosis, sagittal condylar shape variations, increased tibial slope, decreased tibial eminence size, poor tibiofemoral alignment, and decreased ACL size were the risk factors for ACL injury.…”

Section: Discussionmentioning

confidence: 99%

“…The results from a recent research have shown that several intrinsic and extrinsic factors are responsible for ACL injuries. [ 6 ] Morphometric features such as the tibial slope,[ 7 , 8 ] notch width (NW),[ 9 ] notch shape,[ 10 ] NW index (NWI),[ 11 ] and the tibial tubercletrochlear groove (TT-TG) distance[ 12 ] have been studied individually to identify whether they are predisposing factors in ACL injury. Although there is evidence that some morphometric features such as a decreased intercondylar NW may cause ACL injury, a clear link between ACL injury risk and the morphometric parameters of the knee has not been fully established, yet.…”

Section: Introductionmentioning

confidence: 99%

Morphometric risk factors effects on anterior cruciate ligament injury

Gültekin¹,

Dinçel

Keskin

et al. 2022

Jt Dis Relat Surg

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Objectives This study aims to compare the morphometric differences between patients with and without an anterior cruciate ligament (ACL) injury and to investigate the anatomical risk factors associated with ACL injury. Patients and methods Between February 2020 and February 2022, a total of 100 patients (57 males, 43 females; mean age: 36.2±6.8 years; range, 18 to 45 years) who were operated for isolated non-contact ACL tear as the patient group and a total of 100 healthy individuals (58 males, 42 females; mean age: 35.0±6.9 years; range, 18 to 45 years) without an ACL tear as the control group were included. Magnetic resonance imaging scans of the knee joint were included in the study. Morphological variables of the ACL, distal femur, proximal tibia, and menisci were measured. Results The mean ACL inclination angle and medial meniscus bone angle were 37.7±3.8 and 20.2±2.9 in the patient group and 48.1±3.3 and 25.0±2.9 in the control group. According to the results of multivariate analysis, those with small ACL inclination angle and medial meniscus bone angle were more likely to have ACL tear (odds ratio: 0.128, intraclass correlation coefficient: 0.038-0.430, p=0.001). Conclusion Small ACL inclination angle and medial meniscus bone angle can be a risk factor for ACL tear.

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Higher pathologic threshold of increased tibial tuberosity–trochlear groove distance should be considered for taller patients

Wang

Song

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of this study was to evaluate the correlation between tibial tuberosity–trochlear groove distance (TT–TG) and body height or knee size, and to find height‐related pathologic thresholds of increased TT–TG. MethodsOne‐hundred and fifty‐three patients with recurrent patellar instability and 151 controls were included. The TT–TG was measured on axial computed tomography (CT) images. Femora width and tibial width were selected to represent knee size. The correlation of TT–TG and gender, body height, femora width, and tibial width was evaluated. The height‐related pathologic threshold of increased TT–TG was produced according to Dejour’s method. To combine TT–TG with body height and knee size, three new indexes were introduced, ratio of TT–TG to body height (RTH), ratio of TT–TG to femoral width (RTF), and ratio of TT–TG to tibial width (RTT). The ability to predict patellar instability was assessed by the receiver‐operating characteristic (ROC) curve, odds ratios (ORs), sensitivity, and specificity. ResultsIn patients with patellar instability, TT–TG showed significantly correlation with patient height, femoral width, and tibial width respectively (range r = 0.266–0.283). This correlation was not found in the control group. The pathologic threshold of TT–TG was 18 mm in patients < 169 cm (53%), and the mean TT–TG was 21 mm in patients ≥ 169 cm (54%). There was significant difference in RTH, RTF, and RTT between the two groups. RTH, RTF and RTT have similar large area under the curve (AUC) with TT–TG. ConclusionsTT–TG showed significant correlation with body height and knee size, respectively. The pathologic threshold of increased TT–TG was suggested to be 21 mm for patients ≥ 169 cm and 18 mm for patients < 169 cm. Body height‐related pathologic threshold provided a supplement for indications of tibial tuberosity medialization. Level of evidenceIV.

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Tibial tubercle–trochlear groove (TT–TG) distance is a reliable measurement of increased rotational laxity in the knee with an anterior cruciate ligament injury

Cited by 11 publications

References 22 publications

Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

Morphometric risk factors effects on anterior cruciate ligament injury

Higher pathologic threshold of increased tibial tuberosity–trochlear groove distance should be considered for taller patients

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