Top

Clinical Orthopaedics and Related Research®

Published in:

01-08-2012 | Clinical Research

Does Landmark Selection Affect the Reliability of Tibial Tubercle–Trochlear Groove Measurements Using MRI?

Authors: Jason J. Wilcox, MD, Brian J. Snow, MD, Stephen K. Aoki, MD, Man Hung, PhD, Robert T. Burks, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2012

Abstract

Background

A lateralized tibial tubercle is one potential cause of patellar instability. The tibial tubercle–trochlear groove (TT-TG) distance using CT is a reliable measure and considered the gold standard. Using MRI for this purpose has increased, although the reliability of doing so is not well studied.

Questions/purposes

We sought to (1) determine variability in the insertion of the patellar tendon relative to the tibial tubercle and whether this affects the measurement on MRI of the traditional TT-TG distance versus the functional patellar tendon-trochlear groove (PT-TG) distance, (2) determine the reliability of measuring the osseous TT-TG distance, (3) determine the reliability of measuring the soft tissue PT-TG distance, and (4) compare the reliabilities of using osseous (TT-TG) versus soft tissue (PT-TG) landmarks.

Methods

Four observers measured the TT-TG and the PT-TG distances of 50 MR images of knees obtained for any reason. Each observer repeated these measurements 30 days later. The interobserver and intraobserver reliabilities, measurements per observer that varied from the group mean by greater than 2 mm, and the limit of agreement were calculated.

Results

The TT-TG and PT-TG differed by as little as 0.11 mm and by as much as 4.18 mm with an average difference of 1.37 mm. The interobserver and intraobserver reliabilities were greater than 90% for the PT-TG and TT-TG distances. The PT-TG distance was less variable in that this measurement showed interobserver and intraobserver reliabilities of 0.977 and 0.972 respectively, versus 0.913 and 0.961 for the TT-TG measurement. Additionally, the PT-TG measurements resulted in a lower average difference to the mean for each observer, less number of knees per observer where the difference to the mean was greater than 2 mm, and improved limit of agreement.

Conclusions

The TT-TG and the PT-TG distances were not identical and differed by as much as 4.18 mm; as such they are not interchangeable when measuring this distance. Both methods are reliable for measuring lateral offset of the extensor mechanism, but the use of soft tissue landmarks is less variable and thus would provide a more reliable measurement for surgical planning.

Level of Evidence

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Alemparte J, Ekdahl M, Burnier L, Hernandez R, Cardemil A, Cielo R, Danilla S. Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy. 2007;23:170–177.PubMedCrossRef

Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG, Lill H, Sturmer KM, Frosch KH. Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy. 2010;26:926–935.PubMedCrossRef

Balcarek P, Jung K, Ammon J, Walde TA, Frosch S, Schuttrumpf JP, Sturmer KM, Frosch KH. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med. 2010;38:2320–2327.PubMedCrossRef

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.PubMedCrossRef

Cox JS. Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Am J Sports Med. 1982;10:303–310.PubMedCrossRef

Davies AP, Costa ML, Shepstone L, Glasgow MM, Donell S. The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg Br. 2000;82:1162–1166.PubMedCrossRef

Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2:19–26.PubMedCrossRef

Diks MJ, Wymenga AB, Anderson PG. Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc. 2003;11:384–388.PubMedCrossRef

Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32:1114–1121.PubMedCrossRef

10.

Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res. 1983;177:176–181.PubMed

11.

Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations: the natural history. Am J Sports Med. 1986;14:117–120.PubMedCrossRef

12.

Koeter S, Diks MJ, Anderson PG, Wymenga AB. A modified tibial tubercle osteotomy for patellar maltraking: results at two years. J Bone Joint Surg Br. 2007;89:180–185.PubMedCrossRef

13.

Koeter S, Hortsmann WG, Wagenaar FC, Huysse W, Wymenga AB, Anderson PG. A new CT scan method for measuring the tibial tubercle trochlear groove distance in patellar instability. Knee. 2007;14:128–132.PubMedCrossRef

14.

Koskinen SK, Taimela S, Nelimarkka O, Komu M, Jujala UM. Magnetic resonance imaging of patellofemoral relationships. Skeletal Radiol. 1993; 22:403–410.PubMedCrossRef

15.

Kujala UM, Osterman K, Kormano M, Nelimarkka O, Hurme M, Taimela S. Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg Br. 1989;71:788–792.PubMed

16.

Lustig S, Servien E, Ait Si Selmi T, Neyret P. [Factors affecting the reliability of TT-TG measurements before and after medialization: a CT scan study] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2006;92:429–436.PubMedCrossRef

17.

Maquet P. Advancement of the tibial tuberosity. Clin Orthop Relat Res. 1976;115:225–230.PubMed

18.

Post WR, Fulkerson JP. Distal realignment of the patellofemoral joint: indications, effects, results, and recommendations. Orthop Clin North Am. 1992;23:631–643.PubMed

19.

Saudan M, Fritschy D. [AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2000;86:250–255.PubMed

20.

Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance: a comparative study between CT and MRI scanning. Knee. 2006;13:26–31.PubMedCrossRef

21.

Shakespeare D, Fick D. Patellar instability: can the TT-TG distance be measured clinically? Knee. 2005;12:201–204.PubMedCrossRef

22.

Shih YE, Bull AM, Amis AA. The cartilaginous and osseous geometry of femoral trochlear groove. Knee Surg Sports Traumatol Arthrosc. 2004;12:300–306.PubMedCrossRef

23.

Smith TO, Davies L, Toms AP, Hing CB, Donell ST. The reliability and validity of radiological assessment for patellar instability: a systematic review and meta-analysis. Skeletal Radiol. 2011;40:399–414.PubMedCrossRef

24.

Staubli HU, Bosshard C, Porcellini P, Rauschning W. Magnetic resonance imaging for articular cartilage: cartilage-bone mismatch. Clin Sports Med. 2002;21:417–433, viii–ix.CrossRef

25.

Staubli HU, Durrenmatt U, Porcellini P, Rauschning W. Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone Joint Surg Br. 1999;81:452–458.PubMedCrossRef

26.

Toms AP, Cahir J, Swift L, Donell ST. Imaging the femoral sulcus with ultrasound, CT, and MRI: reliability and generalizability in patients with patellar instability. Skeletal Radiol. 2009;38:329–338.PubMedCrossRef

27.

Vahasarja V, Lanning P, Lahde S, Serlo W. Axial radiography or CT in the measurement of patellofemoral malalignment indices in children and adolescents? Clin Radiol. 1996;51:639–643.PubMedCrossRef

28.

van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea: an MRI study. J Bone Joint Surg Br. 2006;88:688–691.PubMedCrossRef

29.

Wagenaar FC, Koeter S, Anderson PG, Wymenga AB. Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation. Knee. 2007;14:51–54.PubMedCrossRef

30.

Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC. Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy. 2006;22:643–649.PubMedCrossRef

Title: Does Landmark Selection Affect the Reliability of Tibial Tubercle–Trochlear Groove Measurements Using MRI?
Authors: Jason J. Wilcox, MD
Brian J. Snow, MD
Stephen K. Aoki, MD
Man Hung, PhD
Robert T. Burks, MD
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2269-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does Landmark Selection Affect the Reliability of Tibial Tubercle–Trochlear Groove Measurements Using MRI?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 8/2012

The Classic: Dislocation and Fracture-Dislocation of the Pelvis

Orthopaedic Case of the Month: Recurrent Thigh Pain in a 44-Year-Old Man

Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study

Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fractures: Meta-analysis of Randomized Trials

MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

Is Fixation Failure After Plate Fixation of the Symphysis Pubis Clinically Important?