Skip to main content
Erschienen in: International Orthopaedics 4/2021

30.09.2020 | Invited Papers

Tibial tuberosity–tibial intercondylar midpoint distance measured on computed tomography scanner is not biased during knee rotation and could be clinically more relevant than current measurement systems

verfasst von: Dinko Nizić, Marko Šimunović, Goran Pavliša, Mislav Jelić

Erschienen in: International Orthopaedics | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this retrospective cross-sectional case-control study was to evaluate an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation.

Methods

On axial CT images of 129 knees, classified as cases (two or more patellar luxations) and controls (no patellar luxations), two raters gauged the standard tibial tuberosity–trochlear groove (TT–TG) distance, tibial tuberosity–femoral intercondylar midpoint (TT–FIM) distance, and new tibial tuberosity–tibial intercondylar midpoint (TT–TIM) distance singly, and knee longitudinal rotation angles (LRAs), and the presence of femoral trochlear dysplasia (FTD) jointly.

Results

All imaging tests intercorrelated and discriminated between stability groups. TT–TIM had the lowest values with the highest precision. Though poorly, TT–TG and TT–FIM negatively correlated with age and LRAs regarding femur, but positively with presence of FTD, whereas TT–TIM was unbiased. The accuracy of TT–TG (> 20 mm), TT–FIM (> 20 mm), and TT–TIM (> 13 mm) was good with almost perfect reproducibility. Only TT–TIM was sex-biased (p = 0.009), with > 12 mm cut-off in females and (presumably) > 14 mm in males.

Conclusion

TT–TIM is an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
2.
Zurück zum Zitat Tan SHS, Lim BY, Chng KSJ, Doshi C, Wong FKL, Lim AKS, Hui JH (2019) The difference between computed tomography and magnetic resonance imaging measurements of tibial tubercle–trochlear groove distance for patients with or without patellofemoral instability: a systematic review and meta-analysis. J Knee Surg. https://doi.org/10.1055/s-0039-1688563 Tan SHS, Lim BY, Chng KSJ, Doshi C, Wong FKL, Lim AKS, Hui JH (2019) The difference between computed tomography and magnetic resonance imaging measurements of tibial tubercle–trochlear groove distance for patients with or without patellofemoral instability: a systematic review and meta-analysis. J Knee Surg. https://​doi.​org/​10.​1055/​s-0039-1688563
7.
12.
Zurück zum Zitat Greene WB, Heckman JD (1994) The clinical measurement of joint motion. American academy of orthopaedic surgeons, Rosemont, pp 4, 5, 115, 116 Greene WB, Heckman JD (1994) The clinical measurement of joint motion. American academy of orthopaedic surgeons, Rosemont, pp 4, 5, 115, 116
22.
Zurück zum Zitat Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale, pp 284–287 Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale, pp 284–287
23.
Zurück zum Zitat Glantz SA (2005) Primer of biostatistics, 6th edn. McGraw-Hill, New York, pp 101–104 Glantz SA (2005) Primer of biostatistics, 6th edn. McGraw-Hill, New York, pp 101–104
24.
Zurück zum Zitat Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70 Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70
29.
Zurück zum Zitat Becher C, Fleischer B, Rase M, Schumacher T, Ettinger M, Ostermeier S, Smith T (2015) Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-015-3829-8 Becher C, Fleischer B, Rase M, Schumacher T, Ettinger M, Ostermeier S, Smith T (2015) Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-015-3829-8
31.
Zurück zum Zitat Hernigou J, Chahidi E, Bouaboula M, Moest E, Callewier A, Kyriakydis T, Koulalis D, Bath O (2018) Knee size chart nomogram for evaluation of tibial tuberosity-trochlear groove distance in knees with or without history of patellofemoral instability. Int Orthop (SICOT). https://doi.org/10.1007/s00264-018-3856-4 Hernigou J, Chahidi E, Bouaboula M, Moest E, Callewier A, Kyriakydis T, Koulalis D, Bath O (2018) Knee size chart nomogram for evaluation of tibial tuberosity-trochlear groove distance in knees with or without history of patellofemoral instability. Int Orthop (SICOT). https://​doi.​org/​10.​1007/​s00264-018-3856-4
36.
Zurück zum Zitat Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, Eng J, Chhabra A (2015) Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-015-3614-8 Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, Eng J, Chhabra A (2015) Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-015-3614-8
37.
Zurück zum Zitat Camp CL, Heidenreich MJ, Dahm DL, Bond JR, Collins MS, Krych AJ (2014) 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. https://doi.org/10.1007/s00167-014-3405-7 Camp CL, Heidenreich MJ, Dahm DL, Bond JR, Collins MS, Krych AJ (2014) 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. https://​doi.​org/​10.​1007/​s00167-014-3405-7
41.
Zurück zum Zitat Williams AA, Elias JJ, Tanaka MJ, Thawait GK, Demehri S, Carrino JA, Cosgarea AJ (2015) The relationship between tibial tuberosity-trochlear groove distance and abnormal patellar tracking in patients with unilateral patellar instability. J Arthrosc Relat Surg:1–7. https://doi.org/10.1016/j.arthro.2015.06.037 Williams AA, Elias JJ, Tanaka MJ, Thawait GK, Demehri S, Carrino JA, Cosgarea AJ (2015) The relationship between tibial tuberosity-trochlear groove distance and abnormal patellar tracking in patients with unilateral patellar instability. J Arthrosc Relat Surg:1–7. https://​doi.​org/​10.​1016/​j.​arthro.​2015.​06.​037
42.
45.
Zurück zum Zitat Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Südkamp NP, Niemeyer P (2013) Influence of knee flexion angle and weight bearing on the tibial tuberosity–trochlear groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-013-2537-5 Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Südkamp NP, Niemeyer P (2013) Influence of knee flexion angle and weight bearing on the tibial tuberosity–trochlear groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-013-2537-5
48.
Zurück zum Zitat Tscholl PM, Antoniadis A, Dietrich TJ, Koch PP, Fucentese SF (2014) The tibial tubercle–trochlear groove distance in patients with trochlear dysplasia: the influence of the proximally flat trochlea. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-014-3386-6 Tscholl PM, Antoniadis A, Dietrich TJ, Koch PP, Fucentese SF (2014) The tibial tubercle–trochlear groove distance in patients with trochlear dysplasia: the influence of the proximally flat trochlea. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-014-3386-6
49.
Zurück zum Zitat Haj-Mirzaian A, Guermazi A, Hakky M, Sereni C, Zikria B, Roemer FW, Tanaka MJ, Cosgarea AJ, Demehri S (2018) Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Eur Radiol. https://doi.org/10.1007/s00330-018-5460-9 Haj-Mirzaian A, Guermazi A, Hakky M, Sereni C, Zikria B, Roemer FW, Tanaka MJ, Cosgarea AJ, Demehri S (2018) Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Eur Radiol. https://​doi.​org/​10.​1007/​s00330-018-5460-9
51.
Zurück zum Zitat Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K, Imhoff AB, Feucht MJ (2019) 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. https://doi.org/10.1007/s00167-019-05542-y Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K, Imhoff AB, Feucht MJ (2019) 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. https://​doi.​org/​10.​1007/​s00167-019-05542-y
52.
Zurück zum Zitat Hirschmann A, Buck FM, Herschel R, Pfirrmann CWA, Fucentese SF (2015) Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-015-3853-8 Hirschmann A, Buck FM, Herschel R, Pfirrmann CWA, Fucentese SF (2015) Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-015-3853-8
56.
Zurück zum Zitat Cao P, Niu Y, Liu C, Wang X, Duan G, Mu Q, Luo X, Wang F (2017) 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. https://doi.org/10.1016/j.knee.2017.10.001 Cao P, Niu Y, Liu C, Wang X, Duan G, Mu Q, Luo X, Wang F (2017) 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. https://​doi.​org/​10.​1016/​j.​knee.​2017.​10.​001
57.
Zurück zum Zitat Heidenreich MJ, Sanders TL, Hevesi M, Johnson NR, Wu IT, Camp CL, Dahm DL, Krych AJ (2017) Individualizing the tibial tubercle to trochlear groove distance to patient specific anatomy improves sensitivity for recurrent instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4752-y Heidenreich MJ, Sanders TL, Hevesi M, Johnson NR, Wu IT, Camp CL, Dahm DL, Krych AJ (2017) Individualizing the tibial tubercle to trochlear groove distance to patient specific anatomy improves sensitivity for recurrent instability. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-017-4752-y
58.
Zurück zum Zitat Guilbert S, Chassaing V, Radier C, Hulet C, Rémy F, Chouteau J, Chotel F, Boisrenoult P, Sebilo A, Ferrua P, Ehkirch FP, Bertin D, Dejour D, the French Arthroscopy Society (SFA) (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99S:S399–S405. https://doi.org/10.1016/j.otsr.2013.10.006CrossRef Guilbert S, Chassaing V, Radier C, Hulet C, Rémy F, Chouteau J, Chotel F, Boisrenoult P, Sebilo A, Ferrua P, Ehkirch FP, Bertin D, Dejour D, the French Arthroscopy Society (SFA) (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99S:S399–S405. https://​doi.​org/​10.​1016/​j.​otsr.​2013.​10.​006CrossRef
61.
Zurück zum Zitat Deveci A, Cankaya D, Yilmaz S, Celen E, Sakman B, Bozkurt M (2016) Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters: the trochlear groove–patellar tendon angle and the trochlear groove–dome angle. J Orthop Surg. https://doi.org/10.1177/2309499016684498 Deveci A, Cankaya D, Yilmaz S, Celen E, Sakman B, Bozkurt M (2016) Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters: the trochlear groove–patellar tendon angle and the trochlear groove–dome angle. J Orthop Surg. https://​doi.​org/​10.​1177/​2309499016684498​
64.
Zurück zum Zitat Kraut B (1997) Krautov strojarski priručnik [Kraut’s mechanical engineering manual]. Axiom, Zagreb, p 25 Kraut B (1997) Krautov strojarski priručnik [Kraut’s mechanical engineering manual]. Axiom, Zagreb, p 25
68.
Zurück zum Zitat Paley D (2002) Principles of deformity correction. Springer-Verlag, Berlin, Heidelberg, New York Paley D (2002) Principles of deformity correction. Springer-Verlag, Berlin, Heidelberg, New York
70.
73.
Zurück zum Zitat Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749CrossRefPubMed Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749CrossRefPubMed
Metadaten
Titel
Tibial tuberosity–tibial intercondylar midpoint distance measured on computed tomography scanner is not biased during knee rotation and could be clinically more relevant than current measurement systems
verfasst von
Dinko Nizić
Marko Šimunović
Goran Pavliša
Mislav Jelić
Publikationsdatum
30.09.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 4/2021
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-020-04820-6

Weitere Artikel der Ausgabe 4/2021

International Orthopaedics 4/2021 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.