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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2018

01-09-2018 | Knee

Current evidence advocates use of a new pathologic tibial tubercle–posterior cruciate ligament distance threshold in patients with patellar instability

Authors: Nickolas Boutris, Domenica A. Delgado, John S. Labis, Patrick C. McCulloch, David M. Lintner, Joshua D. Harris

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2018

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Abstract

Purpose

To determine (1) whether a correlation exists between tibial tubercle–posterior cruciate ligament (TT-PCL) and tibial tubercle–trochlear groove (TT-TG) distances in patellar instability patients; (2) reliability when measuring TT-PCL distance; (3) whether TT-PCL distances measured on MRI are equivalent to those on CT; and (4) whether a correlation exists between TT-PCL distance and number of instability events or recurrence of instability following stabilization surgery.

Methods

A systematic review was performed using PRISMA guidelines. Clinical studies investigating the relationships of TT-PCL with TT-TG on CT and/or MRI in patellar instability patients were sought. English language studies with Levels of evidence I–IV were eligible for inclusion.

Results

Four studies (285 subjects [300 knees] with patellar instability [74.2% female; mean age 26.1 ± 8.2 years]; 114 controls [144 knees; 77% female; mean age 23.1 years]) were included. Mean TT-PCL of instability and control groups was 21.1 ± 4.1 and 18.8 ± 4.0 mm (p < 0.0001), respectively. Two studies reported significant positive (strong and moderate) correlations between TT-PCL and TT-TG MRI measurements in instability patients. All four investigations reported excellent interobserver and intraobserver reliability in MRI measurement of TT-PCL distance. No study compared TT-PCL distances on MRI and CT. No study assessed correlation between TT-PCL distance and number of instability events or recurrence of instability after surgery.

Conclusion

A moderate-to-strong positive correlation exists between TT-PCL and TT-TG measurements taken from MRIs of patellar instability patients. There is excellent interobserver and intraobserver reliability when taking TT-PCL measurements using MRI. This review advocates use of a new pathologic TT-PCL threshold of 21 mm.

Level of evidence

Level III, systematic review of Level II–III studies.
Literature
1.
Anley CM, Morris GV, Saithna A et al (2015) Defining the role of the tibial tubercle-trochlear groove and tibial tubercle-posterior cruciate ligament distances in the work-up of patients with patellofemoral disorders. Am J Sports Med 43(6):1348–1353CrossRefPubMed
2.
Atkins D, Best D, Briss PA et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328(7454):1490–1494CrossRefPubMed
3.
Camp CL, Heidenreich MJ, Dahm DL et al (2016) A simple method of measuring tibial tubercle to trochlear groove distance on MRI: description of a novel and reliable technique. Knee Surg Sports Traumatol Arthrosc 24(3):879–884CrossRefPubMed
4.
Camp CL, Stuart MJ, Krych AJ et al (2013) CT and MRI measurements of tibial tubercle–trochlear groove distances are not equivalent in patients with patellar instability. Am J Sports Med 41(8):1835–1840CrossRefPubMed
5.
Daynes J, Hinckel BB, Farr J (2016) Tibial tuberosity-posterior cruciate ligament distance. J Knee Surg 29(6):471–477CrossRefPubMed
6.
Dejour H, Walch G, Nove-Josserand L et al (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26CrossRefPubMed
7.
Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results. Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428PubMed
8.
Harris JD, Quatman CE, Manring MM et al (2014) How to write a systematic review. Am J Sports Med 42(11):2761–2768CrossRefPubMed
9.
Heidenreich M, Camp CL, Dahm DL et al (2017) The contribution of the tibial tubercle to patellar instability: analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle–posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports Traumatol Arthrosc 25(8):2347–2351CrossRefPubMed
10.
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med 151(4):264–269CrossRefPubMed
11.
Moore DS, Notz WI, Flinger MA (2013) The basic practice of statistics, 6th edn. WH Freeman and Company, New York
12.
Rossi MJ (2016) Editorial commentary: tibial tubercle-trochlear groove distance as an independent risk factor for noncontact anterior cruciate ligament injury is possible but remains uncertain. Arthroscopy 32(1):69–70CrossRefPubMed
13.
Seitlinger G, Scheurecker G, Högler R et al (2012) Tibial tubercle-posterior cruciate ligament distance a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40(5):1119–1125CrossRefPubMed
14.
Slavin RE (1995) Best evidence synthesis: an intelligent alternative to metaanalysis. J Clin Epidemiol 48(1):9–18CrossRefPubMed
15.
Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMed
16.
Tompkins MA, Arendt EA (2015) Patellar instability factors in isolated medial patellofemoral ligament reconstructions—what does the literature tell us? A systematic review. Am J Sports Med 43(9):2318–2327CrossRefPubMed
17.
Von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med 45(4):247–251CrossRef
Metadata
Title
Current evidence advocates use of a new pathologic tibial tubercle–posterior cruciate ligament distance threshold in patients with patellar instability
Authors
Nickolas Boutris
Domenica A. Delgado
John S. Labis
Patrick C. McCulloch
David M. Lintner
Joshua D. Harris
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4716-2

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