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Badres IA, Talbot S, Bartlett J. Long-Term Follow-Up of the Roux-Goldthwait Patellar Stabilization Procedure in a Predominantly Adult Population. Cureus 2023; 15:e39890. [PMID: 37404389 PMCID: PMC10315197 DOI: 10.7759/cureus.39890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Background The Roux-Goldthwait patellar stabilisation (R-G) involves the medial transfer of the distal attachment of the lateral half of the patellar tendon. This paper reviews the long-term results of the R-G in a predominantly adult population. Methodology This is a retrospective study looking at patients with recurrent patellar instability who were treated with an R-G technique by a single surgeon over a 36-year period from 1976 to 2012. The primary outcomes measured were further patella instability and further knee surgical procedures. Results A total of 202 knees in 170 patients were analysed in this study. Patients between the ages of 9 and 70 years old (average 21 years old) were included in this study. The operative procedure changed during the study period. Initially, patients did not undergo concurrent arthroscopy. Early patients were likely to have additional lateral releases and open medial reefing procedures. More recent patients were more likely to undergo an isolated R-G procedure via a minimally invasive incision. The most common further operative procedure was arthroscopy of the knee for chondral pathology at 13.9%. These were more common early in the study period when patients did not have an initial arthroscopy. Recurrent dislocation was reported at 12.9%, with 5.9% of patients having revision stabilisation surgery, at a mean of 5.58 years (range = 1-15 years) postoperatively. Conclusions The R-G procedure is effective in treating recurrent patellar instability in both the paediatric and adult population. It can be performed as an isolated and minimally invasive procedure which is technically simple and has low morbidity.
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Affiliation(s)
- Inas A Badres
- Department of Orthopaedic Surgery, Western Health, Melbourne, AUS
| | - Simon Talbot
- Department of Orthopaedic Surgery, Western Health, Melbourne, AUS
| | - John Bartlett
- Department of Orthopaedic Surgery, Warringal Private Hospital, Melbourne, AUS
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Gardner EC, Molho DA, Fulkerson JP. Coronal Malalignment-When and How to Perform a Tibial Tubercle Osteotomy. Clin Sports Med 2021; 41:15-26. [PMID: 34782071 DOI: 10.1016/j.csm.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.
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Affiliation(s)
- Elizabeth C Gardner
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA.
| | - David A Molho
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA. https://twitter.com/TotalHipKnee
| | - John P Fulkerson
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA. https://twitter.com/patelladoc
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Biedert RM. Patella Alta: When to Correct and Impact on Other Anatomic Risk Factors for Patellofemoral Instability. Clin Sports Med 2021; 41:65-76. [PMID: 34782076 DOI: 10.1016/j.csm.2021.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.
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Affiliation(s)
- Roland M Biedert
- SportsClinic#1, Wankdorf Center, Papiermühlestrasse 73, CH-3014 Bern, Switzerland.
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4
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Ghany JF, Kamel S, Zoga A, Farrell T, Morrison W, Belair J, Desai V. Extensor mechanism tendinopathy in patients with lateral patellar maltracking. Skeletal Radiol 2021; 50:2205-2212. [PMID: 33876276 DOI: 10.1007/s00256-021-03787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. MATERIALS AND METHODS Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. RESULTS The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2 years versus 48.2 years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49 mm versus 14.99 mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4 mm versus 15.4 mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). CONCLUSION Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.
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Affiliation(s)
- Jehan F Ghany
- Musculoskeletal Radiology, Department of Radiology, The Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Sarah Kamel
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Adam Zoga
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Terence Farrell
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - William Morrison
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Jeffrey Belair
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
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Kim JM, Sim JA, Yang H, Kim YM, Wang JH, Seon JK. Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability. Am J Sports Med 2021; 49:3335-3343. [PMID: 34494477 DOI: 10.1177/03635465211037716] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity-trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. PURPOSE To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). RESULTS All of the clinical outcome parameters significantly improved in both groups at the final follow-up (P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups (P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. CONCLUSION MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.
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Affiliation(s)
- Jong-Min Kim
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Ang Sim
- Department of Orthopaedic Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - HongYeol Yang
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
| | - Young-Mo Kim
- Department of Orthopaedic Surgery, ChoongNam National University, College of Medicine and Hospital, Daejeon, Republic of Korea
| | - Joon-Ho Wang
- Department of Orthopaedic Surgery, Sungkyunkwan University, College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
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McFarlane KH, Coene RP, Feldman L, Miller PE, Heyworth BE, Kramer DE, Kocher MS, Yen YM, Milewski MD. Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients. J Child Orthop 2021; 15:149-156. [PMID: 34040661 PMCID: PMC8138795 DOI: 10.1302/1863-2548.15.200225] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Patellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014. METHODS The Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures. RESULTS Between 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries. CONCLUSION This study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kelly H. McFarlane
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US
| | - Ryan P. Coene
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US
| | - Lanna Feldman
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US
| | - Patricia E. Miller
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US
| | - Benton E. Heyworth
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US
| | - Dennis E. Kramer
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US
| | - Mininder S. Kocher
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US
| | - Yi-Meng Yen
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US
| | - Matthew D. Milewski
- Boston Children’s Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, MA, US,Harvard Medical School, Boston, MA, US,Correspondence should be sent to Matthew D. Milewski, Boston Children’s Hospital, Orthopaedic Surgery & Sports Medicine, 300 Longwood Avenue, Boston, MA 02115, US.
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Burnham JM, Howard JS, Hayes CB, Lattermann C. Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications. Arthroscopy 2016; 32:1185-95. [PMID: 26882966 DOI: 10.1016/j.arthro.2015.11.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the outcomes and complications of medial patellofemoral ligament (MPFL) reconstruction and concomitant tibial tubercle (TT) transfer. METHODS A systematic review of published literature on MPFL reconstruction and TT transfer was performed using the following databases: PubMed/Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, and Cochrane. To be included, studies were required to present outcomes and/or complication data for MPFL reconstruction performed in combination with TT transfer. Each study was assessed for quality and level of evidence. RESULTS Five studies consisting of 92 knees met the inclusion criteria. Between 57% and 77% of the patients were female patients, and the mean age at surgery was 20.6 years (range, 19 to 31 years). The mean follow-up period was 38 months (range, 23 to 53 months). Postoperative outcome measures including the Lysholm score, Kujala score, International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, and visual analog scale score were similar to those previously reported for isolated MPFL reconstruction. Reported complication rates were lower than 15% and included wound infection, hardware irritation, and stiffness. Four studies were graded as Level IV evidence, and 1 study was graded as Level II evidence. Only 1 study scored greater than 50% in the quality analysis. CONCLUSIONS Results from the analyzed studies indicate that MPFL reconstruction combined with TT transfer is a safe and effective procedure, with a low to moderate risk of complications but overall favorable results. TT transfer is most often performed in conjunction with MPFL reconstruction in the setting of malalignment such as an increased TT-to-trochlear groove distance, and although the surgical indications may differ, the outcomes and risk profiles are similar to those of isolated MPFL reconstruction. With the recognition that these patients are difficult to standardize, additional well-designed studies are needed to further investigate the ideal surgical candidates for MPFL reconstruction with concomitant TT transfer. LEVEL OF EVIDENCE Level IV, systematic review of Level II and IV studies.
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Affiliation(s)
- Jeremy M Burnham
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
| | - Jennifer S Howard
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Christopher B Hayes
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Christian Lattermann
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
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Hall MJ, Mandalia VI. Tibial tubercle osteotomy for patello-femoral joint disorders. Knee Surg Sports Traumatol Arthrosc 2016; 24:855-61. [PMID: 25326765 DOI: 10.1007/s00167-014-3388-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/10/2014] [Indexed: 11/25/2022]
Abstract
Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III.
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Affiliation(s)
- Matthew J Hall
- Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, Somerset, UK.
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Dickschas J, Harrer J, Bayer T, Schwitulla J, Strecker W. Correlation of the tibial tuberosity-trochlear groove distance with the Q-angle. Knee Surg Sports Traumatol Arthrosc 2016; 24:915-20. [PMID: 25416671 DOI: 10.1007/s00167-014-3426-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/06/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE The Q-angle has been used for years to quantify lateralization of the patella. The tibial tuberosity-trochlea groove distance (TT-TG distance) was introduced to analyse patellar tracking. Does a significant correlation exist between these two parameters? Do other significant interrelations exist between the Q-angle/TT-TG distance, torsion of the femur and tibia, the frontal axis, overall leg length, gender, former patellar dislocation, BMI? METHODS One hundred knees in 55 patients with patellofemoral symptoms were included in a prospective study. All patients underwent clinical examination, including measurement of the Q-angle. A torsional CT was obtained from all patients. RESULTS The correlation coefficient was 0.33/0.34 (left/right leg), showing that the TT-TG distance tends to rise in direct ratio to a rising Q-angle. Thus, a significant correlation was found (p = 0.017). Femoral and tibial torsion had a positive effect on the TT-TG distance, but showed no significant correlation. Leg length had a significant effect on the TT-TG distance (p = 0.04). The frontal axis had a nonsignificant influence on the Q-angle or TT-TG distance. On average, the Q-angle in women was 2.38° greater than it was in men, but the difference was not significant. CONCLUSION A significant correlation was noted between the Q-angle and the TT-TG distance. Both depend on various parameters and must be assessed for the analysis of patellofemoral maltracking. The Q-angle did not differ significantly between men and women; thus, the conclusion is that no different ranges need not be used. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
| | - Jörg Harrer
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
| | - Thomas Bayer
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Judith Schwitulla
- Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstr. 6, 91054, Erlangen, Germany. .,, Universitätsstr. 22, 91052, Erlangen, Germany.
| | - Wolf Strecker
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
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Kittl C, Schmeling A, Amis A. Das Patellofemoralgelenk. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Anley CM, Morris GV, Saithna A, James SL, Snow M. 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 2015; 43:1348-53. [PMID: 25813867 DOI: 10.1177/0363546515576128] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The radiological work-up of patients with patellofemoral disorders continues to be debated. The interchangeability of the tibial tubercle-trochlear groove (TT-TG) distance between computed tomography (CT) and magnetic resonance imaging (MRI) has recently been questioned. In addition, a new measurement-the tibial tubercle-posterior cruciate ligament (TT-PCL) distance-has shown that not all patients with a pathological TT-TG distance (>20 mm) have lateralization of the tibial tubercle. Another factor to consider when looking at the position of the tibial tubercle is the knee joint rotation, defined as the angle between the femoral dorsal condylar line and the tibial dorsal condylar line. PURPOSE To determine, with a larger population, if the TT-TG measurements can be used interchangeably between CT and MRI and to confirm the correlation between the TT-PCL and TT-TG distances in determining tibial tubercle lateralization. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Patients with patellofemoral disorders and MRI and CT scans of the same knee (n = 141) were identified. The TT-PCL, the knee joint rotation, and TT-TG were measured independently by 2 fellowship-trained orthopaedic surgeons. Thirty measurements were repeated on a separate occasion to allow for an assessment of the intrarater reliability. The intraclass correlation coefficient (ICC) was used to assess reliability of the measurements. RESULTS The mean TT-TG was 4.16 mm less on MRI (P < .05), with the mean TT-TG ± SD being 17.72 ± 5.15 mm on CT (range, 6.97-31.33 mm) and 13.56 ± 6.07 mm on MRI (range, 2-30.04 mm). The ICC for each rater comparing the 2 imaging modalities was only fair (0.54 and 0.48). The mean TT-PCL measurement was 20.32 ± 3.45 mm (range, 10.11-32.01 mm) with excellent interobserver and intraobserver reliability (>0.75). Based on the TT-TG and TT-PCL measurements, 4 groups of patients can be established. When knee joint rotation is compared among groups, an increased TT-TG may result from true lateralization of the tibial tubercle, an increased knee joint rotation, or both. CONCLUSION Based on a statistically significant mean difference (4.11 mm) and only a fair ICC (0.54 and 0.48) for raters comparing the 2 modalities, the measurements for the TT-TG cannot be used interchangeably between CT and MRI. Therefore, currently accepted values for TT-TG based on CT scans should not be applied to an MRI scan. The TT-PCL measurement is a measure of true lateralization of the tibial tubercle, while the TT-TG is an amalgamated measure of true lateralization and knee joint rotation.
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Affiliation(s)
| | - Guy Vernon Morris
- Arthroscopy Division, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Adnan Saithna
- Arthroscopy Division, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Martyn Snow
- Arthroscopy Division, The Royal Orthopaedic Hospital, Birmingham, UK
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Abstract
When appropriately indicated, distal realignment procedures can produce consistent clinical results. Indications for distal realignment include lateral patellofemoral instability, anterior knee pain with associated lateral or distal patellofemoral cartilage lesion, and cases with significant lateral patellofemoral overload or tilt. In cases of patellofemoral instability, it is important to determine whether proximal stabilization, distal realignment, or both is needed. If distal realignment is indicated, several anatomic variables must be considered to determine the location and obliquity of the osteotomy when using multiplanar osteotomy techniques.
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