Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2023

01-04-2022 | KNEE

Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty

Authors: Stefan M. Zimmermann, Yves Scherrer, Martin Zaleski, Thorsten Jentzsch, Sandro F. Fucentese

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

Login to get access

Abstract

Purpose

Anterior knee pain (AKP) is common following total knee arthroplasty. The tibial tuberosity trochlear groove distance (TTTG) influences patellofemoral joint loading in the native knee. Increased TTTG may lead to maltracking of the patella and anterior knee pain. The purpose of this study was to investigate potential changes in TTTG following total knee arthroplasty (TKA).

Methods

TTTG was measured on preoperative CT data on a consecutive series of patients scheduled to receive TKA with patient-specific instrumentation, and compared to a computer simulation of the postoperative TTTG. Preoperative TTTG was measured with a 3D planning software in 250 knees. The postoperative result was simulated and TTTG measured within the software. Three different groups were analysed: neutral (180° ± 3) (n = 50), valgus (> 190°) (n = 100), and varus (< 170°) (n = 100).

Results

Median preoperative to simulated postoperative TTTG decreased from 15.0 [interquartile range (IQR) 6.0] mm to 6.5 (IQR 5.0) mm for all axes combined. A significant postoperative reduction of TTTG was found in each group (p < 0.001). The mean change in TTTG did not differ significantly between the groups [− 8.8 (IQR 5.5) mm neutral, − 8.3 (IQR 7.0) mm valgus, − 7.5 (IQR 5.8) mm varus, p = 0.223].

Conclusion

This computer-based study suggests that mechanically aligned TKA significantly decreases TTTG distance in neutral, valgus and varus knees, assuming that the postoperative result coincides with the preoperative planning. Further study is warranted to evaluate the clinical relevance of this finding.
Literature
1.
Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177CrossRef
2.
Ascani D, Mazzà C, De Lollis A, Bernardoni M, Viceconti M (2015) A procedure to estimate the origins and the insertions of the knee ligaments from computed tomography images. J Biomech 48:233–237CrossRefPubMed
3.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ, Wales N (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900CrossRefPubMed
4.
Balcarek P, Jung K, Frosch KH, Stürmer KM (2011) Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39:1756–1761CrossRefPubMed
5.
6.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63CrossRefPubMed
7.
Chester R, Smith TO, Sweeting D, Dixon J, Wood S, Song F (2008) The relative timing of VMO and VL in the aetiology of anterior knee pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 9:64CrossRefPubMedPubMedCentral
8.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed
9.
Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed
10.
Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22:214–218CrossRefPubMed
11.
Dietrich TJ, Fucentese SF, Pfirrmann CW (2016) Imaging of individual anatomical risk factors for patellar instability. Semin Musculoskelet Radiol 20:65–73CrossRefPubMed
12.
Dornacher D, Reichel H, Kappe T (2016) Does tibial tuberosity-trochlear groove distance (TT-TG) correlate with knee size or body height? Knee Surg Sports Traumatol Arthrosc 24:2861–2867CrossRefPubMed
13.
Galland O, Walch G, Dejour H, Carret JP (1990) An anatomical and radiological study of the femoropatellar articulation. Surg Radiol Anat 12:119–125CrossRefPubMed
14.
Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 64:423–428PubMed
15.
Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85:480–487CrossRefPubMedPubMedCentral
16.
Hess S, Fromm T, Schiapparelli F, Moser LB, Robertson E, Amsler F et al (2021) Change of tibial tuberosity-trochlear groove (TT-TG) distance during total knee arthroplasty had no influence on clinical outcome and anterior knee pain. Int Orthop 45:3069–3074CrossRefPubMed
17.
Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F (2014) The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc 22:2388–2395CrossRefPubMed
18.
Ho CP, James EW, Surowiec RK, Gatlin CC, Ellman MB, Cram TR et al (2015) Systematic technique-dependent differences in CT versus MRI measurement of the tibial tubercle-trochlear groove distance. Am J Sports Med 43:675–682CrossRefPubMed
19.
Hochreiter B, Hirschmann MT, Amsler F, Behrend H (2019) Highly variable tibial tubercle-trochlear groove distance (TT-TG) in osteoarthritic knees should be considered when performing TKA. Knee Surg Sports Traumatol Arthrosc 27:1403–1409CrossRefPubMed
20.
Indelli PF, Graceffa A, Marcucci M, Baldini A (2016) Rotational alignment of the tibial component in total knee arthroplasty. Ann Transl Med 4:3PubMedPubMedCentral
21.
Kohl S, Evangelopoulos DS, Hartel M, Kohlhof H, Roeder C, Eggli S (2011) Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow? Knee Surg Sports Traumatol Arthrosc 19:1453–1459CrossRefPubMed
22.
Konno T, Onodera T, Nishio Y, Kasahara Y, Iwasaki N, Majima T (2014) Correlation between knee kinematics and patellofemoral contact pressure in total knee arthroplasty. J Arthroplasty 29:2305–2308CrossRefPubMed
23.
Malo M, Vince KG (2003) The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg 11:364–371CrossRefPubMed
24.
McPherson EJ (2006) Patellar tracking in primary total knee arthroplasty. Instr Course Lect 55:439–448PubMed
25.
26.
Nakamura S, Shima K, Kuriyama S, Nishitani K, Ito H, Matsuda S (2019) Tibial tubercle-trochlear groove distance influences patellar tilt after total knee arthroplasty. J Arthroplast 34:3080–3087CrossRef
27.
Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43CrossRefPubMed
28.
Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803CrossRefPubMedPubMedCentral
29.
Pennock AT, Alam M, Bastrom T (2014) Variation in tibial tubercle-trochlear groove measurement as a function of age, sex, size, and patellar instability. Am J Sports Med 42:389–393CrossRefPubMed
30.
Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG et al (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38:319–328CrossRefPubMed
31.
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71:262–267CrossRefPubMed
32.
Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31CrossRefPubMed
33.
Seitlinger G, Beitzel K, Scheurecker G, Imhoff A, Hofmann S (2011) The painful patellofemoral joint. Biomechanics, diagnosis and therapy. Orthopade 40:353–368 (quiz 369–370)CrossRefPubMed
34.
Shervin D, Pratt K, Healey T, Nguyen S, Mihalko WM, El-Othmani MM et al (2015) Anterior knee pain following primary total knee arthroplasty. World J Orthop 6:795–803CrossRefPubMedPubMedCentral
35.
Skelley N, Friedman M, McGinnis M, Smith C, Hillen T, Matava M (2015) Inter- and intraobserver reliability in the MRI measurement of the tibial tubercle-trochlear groove distance and trochlea dysplasia. Am J Sports Med 43:873–878CrossRefPubMed
36.
37.
38.
Zmistowski B, Restrepo C, Kahl LK, Parvizi J, Sharkey PF (2011) Incidence and reasons for nonrevision reoperation after total knee arthroplasty. Clin Orthop Relat Res 469:138–145CrossRefPubMed
Metadata
Title
Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty
Authors
Stefan M. Zimmermann
Yves Scherrer
Martin Zaleski
Thorsten Jentzsch
Sandro F. Fucentese
Publication date
01-04-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-06952-1

Other articles of this Issue 3/2023

Knee Surgery, Sports Traumatology, Arthroscopy 3/2023 Go to the issue

KNEE

Successful same-day discharge in 88% of patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis

KNEE

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

KNEE

Aseptic revision total knee arthroplasty outcomes were equivalent to patients’ own pre-failure state but inferior to patients without revision

KNEE

The limited use of a tourniquet during total knee arthroplasty under a contemporary enhanced recovery protocol has no meaningful benefit: a prospective randomized controlled trial

KNEE

Thicker polyethylene inserts (≥ 13 mm) increase the risk for early failure after primary cruciate-retaining total knee arthroplasty (TKA): a single-centre study of 7643 TKAs

KNEE

Joint gap produced by manual stress is dependent on the surgeon’s experience and is smaller in flexion in robotic-assisted total knee arthroplasty