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Tibial tubercle trochlear groove distance

Matthew Stepanovich, James D Bomar, Andrew T Pennock
BACKGROUND: The assessment and classification of trochlear dysplasia in pediatric patients has yet to be well documented or validated. PURPOSE: To examine several different measurements/classifications of trochlear dysplasia in skeletally immature patients to assess inter- and intraobserver reliability and to determine which best correlates with patellar instability. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Radiographs and magnetic resonance imaging (MRI) scans of 36 skeletally immature patients undergoing surgery for patellar instability were compared with 27 age-matched cohort patients who had similar imaging for an acute knee injury but no clinical evidence of patellar instability...
October 2016: Orthopaedic Journal of Sports Medicine
Marie Askenberger, Per-Mats Janarv, Throstur Finnbogason, Elizabeth A Arendt
BACKGROUND: The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. PURPOSE: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle-trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups...
September 9, 2016: American Journal of Sports Medicine
C S N Yeoh, K Y Lam
PURPOSE: To compare the tibial tubercle to trochlear groove (TT-TG) distance and index using magnetic resonance imaging (MRI) between children with onetime and recurrent patellar dislocation. METHODS: Records of first-time acute patellar dislocations from 2007 to 2012 were reviewed. 20 males and 23 females aged 10 to 17 years at presentation were included for measurements of the bony and cartilaginous-tendon TT-TG distance and index. Recurrent patellar dislocation was defined as having more than one episode of dislocation within 2 years of the index injury...
August 2016: Journal of Orthopaedic Surgery
Chase S Dean, Jorge Chahla, Raphael Serra Cruz, Tyler R Cram, Robert F LaPrade
Recurrent patellar instability can be very debilitating and may require surgical intervention. A thorough workup must be completed in this subset of patients. Risk factors for recurrent instability include patella alta, trochlear dysplasia, an increased tibial tubercle-trochlear groove distance, and insufficiencies in the medial retinacular structures. Necessary treatment of these risk factors, once identified, should be addressed surgically. Patellofemoral reconstruction must be individually tailored to each patient's anatomy and may necessitate medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, or trochleoplasty in any combination or as a standalone procedure...
February 2016: Arthroscopy Techniques
Alan Edwards, Evan Larson, Mitchell Beckert, Nikhil Sahai, John P Albright
BACKGROUND: Tibial tubercle-trochlear groove (TT-TG) distance is currently used at our institution to determine tibial tubercle medialization required in Fulkerson osteotomies. If the correlation between a modified lateral patellar edge (LPE) and the transfer distance was found to be stronger than its correlation with TT-TG, it would suggest that the best measurement to use is actually modified LPE. METHODS: The electronic medical records of 32 patients who underwent Fulkerson osteotomy procedures with femoral nerve stimulation were reviewed and measured...
August 2016: Knee
Tobias J Dietrich, Sandro F Fucentese, Christian W A Pfirrmann
This review article presents several pitfalls and limitations of image interpretation of anatomical risk factors for patellar instability. The most important imaging examinations for the work-up of patients with patellar instability are the true lateral radiograph and transverse computed tomography (CT) or MR images of the knee. Primary anatomical risk factors are an insufficient medial patellofemoral ligament (MPFL), patella alta, trochlear dysplasia, increased distance from the tibial tuberosity to the trochlear groove (TTTG), and torsional limb parameters...
February 2016: Seminars in Musculoskeletal Radiology
Zhu Dai, Di You, Ying Liao, Zhiwei Chen, Jiabin Peng
OBJECTIVE: To explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. METHODS: Between August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7...
January 2016: Chinese Journal of Reparative and Reconstructive Surgery
Riaz Ahmad, Marius Calciu, Narlaka Jayasekera, Peter Schranz, Vipul Mandalia
There is limited data on the effectiveness of combined medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle transfer (TTT) in patients with patella instability. The aim of our study was to analyze the functional outcome in patients treated with MPFL reconstruction and TTT. Between July 2008 and April 2013, 18 patients (21 knees) underwent combined MPFL reconstruction and TTT; 15 patients (16 knees) with a mean age of 24 years (16-41) had a mean follow-up of 30 months (26-55). There was significant improvement in outcome scores in 12 out of 15 patients...
March 10, 2016: Journal of Knee Surgery
Alexander E Weber, Amit Nathani, Joshua S Dines, Answorth A Allen, Beth E Shubin-Stein, Elizabeth A Arendt, Asheesh Bedi
High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus...
March 2, 2016: Journal of Bone and Joint Surgery. American Volume
Jeremy M Burnham, Jennifer S Howard, Christopher B Hayes, Christian Lattermann
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...
June 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Shuhei Otsuki, Mikio Nakajima, Kenta Fujiwara, Yoshinori Okamoto, Go Iida, Tomohiko Murakami, Masashi Neo
PURPOSE: To evaluate the clinical outcomes of three-dimensional (3D) transfer of the tibial tuberosity for patellar instability with patella alta, with a focus on the influence of age at initial surgery. METHODS: Three-dimensional surgery was performed on 28 knees with a mean follow-up of 46 months. Patients were separated into three groups based on the age at initial surgery: group A, 10 knees and an average age of 16.3 ± 1.8 (14-19) years; group B, 10 knees and an average age of 22...
February 2, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
David Y Ding, Raymond Kanevsky, Eric J Strauss, Laith M Jazrawi
INTRODUCTION: Recurrent patellar instability can be a source of continued pain and functional limitation in the young, active patient population. Instability in the setting of an elevated tibial tubercle-trochlear groove (TT-TG) distance can be effectively managed with a tibial tubercle osteotomy. At the present time, clinical outcome data are limited with respect to this surgical approach to patellar instability. METHODS: A retrospective chart review was performed to identify all cases of tibial tubercle osteotomy for the management of patellar instability performed at our institution with at least 1 year of post-operative follow-up...
March 2016: Injury
Alicia Worden, Scott Kaar, Joshua Owen, Adnan Cutuk
Background A lateralized tibial tubercle is an important anatomic predictor of patellar instability and can be used as an indication for a distal realignment procedure. Currently, tibial tubercle to trochlear groove (TT-TG) distance is measured on computed tomography (CT); however, radiographs could be a safer and more efficient modality. The aim of this study is to evaluate and compare TT-TG measurements obtained using CT, anatomical dissections, and a novel radiographic technique. Furthermore, we evaluated the effects of knee flexion and tibial rotation on these measurements...
December 30, 2015: Journal of Knee Surgery
Li Yin, Cheng Chen, Xiaojun Duan, Bing Deng, Ran Xiong, Fuyou Wang, Liu Yang
BACKGROUND: The purpose of the present study was to determine whether the image levels of the distal femur affected the measurement of the tibial tubercle-trochlear groove (TT-TG) distance. METHODS: Thirty sets of computer tomography (CT) images and 30 sets of MR images of the knee were evaluated. The TT-TG distance was quantified at multiple image levels in 1.5-mm increments, covering the proximodistal range of the trochlear groove. The CT measurement was based on osseous landmarks; the magnetic resonance imaging (MRI) measurement was based on cartilaginous and osseous landmarks...
November 16, 2015: Journal of Orthopaedic Surgery and Research
Betina B Hinckel, Riccardo G Gobbi, Eduardo N Kihara Filho, Marco K Demange, José Ricardo Pécora, Gilberto Luis Camanho
BACKGROUND: The tibial tubercle-trochlear groove (TT-TG) is used as the gold standard for patellofemoral malalignment. PURPOSE: To assess 3 patellar tendon-trochlear groove (PT-TG) angle measurement techniques and the PT-TG distance measurement (tendinous cartilaginous TT-TG) as predictors of patellar instability. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Three PT-TG angle measurements and the PT-TG distance were measured in 82 participants with patellar instability and 100 controls using magnetic resonance imaging (MRI)...
September 2015: Orthopaedic Journal of Sports Medicine
Keisuke Kita, Yoshinari Tanaka, Yukiyoshi Toritsuka, Hiroshi Amano, Ryohei Uchida, Rikio Takao, Shuji Horibe
BACKGROUND: Many factors are involved in causing patellar instability or recurrent patellar dislocations. However, factors affecting the outcomes of anatomic medial patellofemoral ligament (MPFL) reconstruction have not been fully documented. PURPOSE: To evaluate the rate of recurrent patellar instability after isolated MPFL reconstruction and to elucidate factors affecting the outcomes of isolated MPFL reconstruction using multivariable statistics. STUDY DESIGN: Case-control study; Level of evidence, 3...
December 2015: American Journal of Sports Medicine
Michael G Saper, John M Popovich, Ryan Fajardo, Shane Hess, Jeremy L Pascotto, Michael Shingles
PURPOSE: To determine differences in tibial tubercle-trochlear groove (TT-TG) distance between patients with a history of noncontact anterior cruciate ligament (ACL) injury and an uninjured control group. METHODS: MRI studies of 60 patients (age range, 14 to 25 years) with ACL-deficient (ACLD) knees were compared with 60 intact-ACL controls. All patients underwent MRI after a noncontact sports injury. TT-TG distances were measured on proton density-weighted axial images...
January 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Keiji Tensho, Yusuke Akaoka, Hiroki Shimodaira, Seiji Takanashi, Shota Ikegami, Hiroyuki Kato, Naoto Saito
BACKGROUND: The tibial tuberosity-trochlear groove distance is used as an indicator for medial tibial tubercle transfer; however, to our knowledge, no studies have verified whether this distance is strongly affected by tubercle lateralization at the proximal part of the tibia. We hypothesized that the tibial tuberosity-trochlear groove distance is mainly affected by tibial tubercle lateralization at the proximal part of the tibia. METHODS: Forty-four patients with a history of patellar dislocation and forty-four age and sex-matched controls were analyzed with use of computed tomography...
September 2, 2015: Journal of Bone and Joint Surgery. American Volume
Clare K Fitzpatrick, Robert N Steensen, Aruna Tumuluri, Thai Trinh, Jared Bentley, Paul J Rullkoetter
Treatment for an initial incidence of patellar dislocation is usually conservative management; however, almost half of patients experience a subsequent, or multiple, dislocation(s). Patients often undergo multiple procedures which fail to treat the underlying anatomic abnormalities. The objective of this study was to evaluate interactions between key predisposing anatomic factors to patellar dislocation and identify combinations of abnormal factors which increase the risk of recurrent lateral dislocation. Four factors associated with lateral patellar dislocation were identified (sulcus angle, Insall-Salvati ratio, tibial tubercle-trochlear groove distance, and femoral anteversion)...
March 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Joanna M Stephen, Alexander L Dodds, Punyawan Lumpaopong, Deiary Kader, Andy Williams, Andrew A Amis
BACKGROUND: Tibial tubercle (TT) transfer and medial patellofemoral ligament (MPFL) reconstruction are used after patellar dislocations. However, there is no objective evidence to guide surgical decision making, such as the ability of MPFL reconstruction to restore normal behavior in the presence of a lateralized TT. HYPOTHESIS: MPFL reconstruction will only restore joint contact mechanics and patellar kinematics for TT-trochlear groove (TG) distances up to an identifiable limit...
September 2015: American Journal of Sports Medicine
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