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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2023

06-03-2023 | Magnetic Resonance Imaging | KNEE

Tibial tubercle to trochlear groove distance versus tibial tubercle to posterior cruciate ligament distance for predicting patellar instability: a systematic review

Authors: Prushoth Vivekanantha, Harjind Kahlon, Ali Shahabinezhad, Dan Cohen, Kanto Nagai, Yuichi Hoshino, Darren de SA

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

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Abstract

Purpose

To determine the reliability and diagnostic accuracy of tibial tubercle–trochlear groove (TT–TG) distance versus tibial tubercle–posterior cruciate ligament (TT–PCL) distance, and to determine cutoff values of these measurements for pathological diagnosis in the context of patellar instability.

Methods

Three databases MEDLINE, PubMed and EMBASE were searched from inception to October 5, 2022 for literature outlining comparisons between TT–TG and TT–PCL in patellar instability patients. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on inter-rater and intra-rater reliability, receiver-operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, as well as odds ratios, cutoff values for pathological diagnosis and correlations between TT–TG and TT–PCL were recorded. The MINORS score was used for all studies in order to perform a quality assessment of included studies.

Results

A total of 23 studies comprising 2839 patients (2922 knees) were included in this review. Inter-rater reliability ranged from 0.71 to 0.98 and 0.55 to 0.99 for TT–TG and TT–PCL, respectively. Intra-rater reliability ranged from 0.74 to 0.99 and 0.88 to 0.98 for TT–TG and TT–PCL, respectively. AUC measuring diagnostic accuracy of patellar instability for TT–TG ranged from 0.80 to 0.84 and 0.58 to 0.76 for TT–PCL. Five studies found TT–TG to have more discriminatory power than TT–PCL at distinguishing patients with patellar instability from patients who do not. Sensitivity and specificity ranged from 21 to 85% and 62 to 100%, respectively, for TT–TG. Sensitivity and specificity ranged from 30 to 76% and 46 to 86%, respectively, for TT–PCL. Odds ratio values ranged from 1.06 to 14.02 for TT–TG and 0.98 to 6.47 for TT–PCL. Proposed cutoff TT–TG and TT–PCL values for predicting patellar instability ranged from 15.0 to 21.4 mm and 19.8 to 28.0 mm, respectively. Eight studies reported significant positive correlations between TT–TG and TT–PCL.

Conclusion

TT–TG resulted in overall similar reliability, sensitivity and specificity as TT–PCL; however, TT–TG has better diagnostic accuracy than TT–PCL in the context of patellar instability as per AUC and odds ratio values.

Level of evidence

Level IV.
Appendix
Available only for authorised users
Literature
1.
Anley CM, Morris GV, Saithna A, James SL, Snow M (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.
3.
Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S, Stein BES (2017) The tibial tubercle-to-trochlear groove distance is reliable in the setting of trochlear dysplasia, and superior to the tibial tubercle-to-posterior cruciate ligament distance when evaluating coronal malalignment in patellofemoral instability. Arthroscopy 33(11):2026–2034PubMed
4.
Camp CL, Heidenreich MJ, Dahm DL, Bond JR, Collins MS, Krych AJ (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
5.
Camp CL, Heidenreich MJ, Dahm DL, Stuart MJ, Levy BA, Krych AJ (2016) Individualizing the tibial tubercle-trochlear groove distance: patellar instability ratios that predict recurrent instability. Am J Sports Med 44(2):393–399CrossRefPubMed
6.
Cao P, Niu Y, Liu C, Wang X, Duan G, Mu Q, Luo X, Wang F (2018) Ratio of the tibial tuberosity-trochlear groove distance to the tibial maximal mediolateral axis: a more reliable and standardized way to measure the tibial tuberosity-trochlear groove distance. Knee 25(1):59–65CrossRefPubMed
7.
Daynes J, Hinckel BB, Farr J (2016) Tibial tuberosity-posterior cruciate ligament distance. J Knee Surg 29(6):471–477CrossRefPubMed
8.
Dong C, Zhao C, Li M, Fan C, Feng X, Piao K, Hao K, Wang F (2021) Accuracy of tibial tuberosity-trochlear groove distance and tibial tuberosity-posterior cruciate ligament distance in terms of the severity of trochlear dysplasia. J Orthop Surg Res 16(1):383CrossRefPubMedPubMedCentral
9.
Dong Z, Zhang X, Xu C, Ji G, Niu Y, Wang F (2022) The tibial tubercle–posterior cruciate ligament (TT–PCL) distance does not truly reflect the lateralization of the tibial tubercle. Knee Surg Sports Traumatol Arthrosc 30(10):3470–3479CrossRefPubMed
10.
11.
Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ (2016) Computational analysis of factors contributing to patellar dislocation. J Orthop Res 34(3):444–453CrossRefPubMed
12.
Friedman MV, Hillen TJ, Misra S, Hildebolt CF, Rubin DA (2020) Quantitative variable assessment of patellar instability: an MRI-based study. AJR Am J Roentgenol 215(5):1163–1170CrossRefPubMed
13.
Geraghty L, Zordan R, Walker P, Chao TW, Talbot S (2022) Patellar dislocation is associated with increased tibial but not femoral rotational asymmetry. Knee Surg Sports Traumatol Arthrosc 30(7):2342–2351CrossRefPubMed
14.
Havey R, Schaver AL, Meyer AM, Duchman KR, Westermann R (2021) Assessment of femoral version should be assessed independently of conventional measures in patellofemoral instability. Iowa Orthop J 41(2):77–81PubMedPubMedCentral
15.
Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ (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
16.
Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K, Imhoff AB, Feucht MJ (2020) The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 28(3):897–904CrossRefPubMed
17.
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed
18.
Matsushita T, Kuroda R, Ok S, Matsumoto T, Takayama K, Kurosaka M (2014) Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity–trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 22(10):2438–2444CrossRefPubMed
19.
McFarlane KH, Coene RP, Feldman L, Miller PE, Heyworth BE, Kramer DE, Kocher MS, Yen Y-M, Milewski MD (2021) Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients. J Child Orthop 15(2):149–156CrossRefPubMedPubMedCentral
20.
Mistovich RJ, Urwin JW, Fabricant PD, Lawrence JTR (2018) Patellar tendon-lateral trochlear ridge distance: a novel measurement of patellofemoral instability. Am J Sports Med 46(14):3400–3406CrossRefPubMed
21.
Nha K, Nam YJ, Shin MJ, Sun SD, Park JY, Debnath R, Lee BH (2019) Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity-trochlear groove distance in patients with higher grades of trochlea dysplasia. Knee 26(6):1429–1436CrossRefPubMed
22.
Schober P, Boer C, Schwarte LA (2018) Correlation coefficients: appropriate use and interpretation. Anesth Analg 126(5):1763–1768CrossRefPubMed
23.
Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31CrossRefPubMed
24.
Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S (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
25.
Shah A, Kay J, Memon M, Coughlin RP, Simunovic N, Nho SJ, Ayeni OR (2019) What makes suture anchor use safe in hip arthroscopy? A systematic review of techniques and safety profile. Arthroscopy 35(4):1280–1293CrossRefPubMed
26.
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMed
27.
28.
29.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMed
30.
Su P, Hu H, Li S, Xu T, Li J, Fu W (2022) Tibial tubercle-trochlear groove/trochlear width is the optimal indicator for diagnosing a lateralized tibial tubercle in recurrent patellar dislocation requiring surgical stabilization. Arthroscopy 38(4):1288–1298CrossRefPubMed
31.
32.
33.
Tanaka MJ, Elias JJ, Williams AA, Carrino JA, Cosgarea AJ (2015) Correlation between changes in tibial tuberosity-trochlear groove distance and patellar position during active knee extension on dynamic kinematic computed tomographic imaging. Arthroscopy 31(9):1748–1755CrossRefPubMed
34.
Tensho K, Shimodaira H, Akaoka Y, Koyama S, Hatanaka D, Ikegami S, Kato H, Saito N (2018) Lateralization of the tibial tubercle in recurrent patellar dislocation: verification using multiple methods to evaluate the tibial tubercle. J Bone Joint Surg Am 100(9):e58CrossRefPubMed
35.
Uimonen M, Ponkilainen V, Hirvinen S, Mattila VM, Kask G, Nurmi H, Paloneva J, Repo JP (2021) The risk of osteochondral fracture after patellar dislocation is related to patellofemoral anatomy. Knee Surg Sports Traumatol Arthrosc 29(12):4241–4250CrossRefPubMed
36.
37.
Weltsch D, Chan CT, Mistovich RJ, Urwin JW, Gajewski CR, Fabricant PD, Lawrence JTR (2021) Predicting risk of recurrent patellofemoral instability with measurements of extensor mechanism containment. Am J Sports Med 49(3):706–712CrossRefPubMed
38.
Williams AA, Elias JJ, Tanaka MJ, Thawait GK, Demehri S, Carrino JA, Cosgarea AJ (2016) The relationship between tibial tuberosity-trochlear groove distance and abnormal patellar tracking in patients with unilateral patellar instability. Arthroscopy 32(1):55–61CrossRefPubMed
39.
Winkler PW, Lutz PM, Rupp MC, Imhoff FB, Izadpanah K, Imhoff AB, Feucht MJ (2021) Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity. Knee Surg Sports Traumatol Arthrosc 29(5):1678–1685CrossRefPubMed
40.
Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI (2022) Patellar instability. Stat Pearls Publishing, Treasure Island, Florida
41.
Xu Z, Song Y, Deng R, Ye J, Wang X, Wang H, Yu J-K (2022) CT and MRI measurements of tibial tubercle lateralization in patients with patellar dislocation were not equivalent but could be interchangeable. Knee Surg Sports Traumatol Arthrosc 31(1):349–357CrossRefPubMed
42.
Xu Z, Zhang H, Yan W, Qiu M, Zhang J, Zhou A (2021) Validating the role of tibial tubercle-posterior cruciate ligament distance and tibial tubercle-trochlear groove distance measured by magnetic resonance imaging in patients with patellar dislocation: a diagnostic study. Arthroscopy 37(1):234–242CrossRefPubMed
43.
44.
Zou Kelly H, James OA, Laura M (2007) Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115(5):654–657CrossRefPubMed
Metadata
Title
Tibial tubercle to trochlear groove distance versus tibial tubercle to posterior cruciate ligament distance for predicting patellar instability: a systematic review
Authors
Prushoth Vivekanantha
Harjind Kahlon
Ali Shahabinezhad
Dan Cohen
Kanto Nagai
Yuichi Hoshino
Darren de SA
Publication date
06-03-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07358-3

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