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Highly variable tibial tubercle–trochlear groove distance (TT–TG) in osteoarthritic knees should be considered when performing TKA

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The tibial tubercle–trochlear groove distance (TT–TG) is an established measurement to assist diagnosis and treatment of patellofemoral instability. However, little is known about the distribution of TT–TG in osteoarthritic knees. The purpose of the current study is to investigate the TT–TG in a large cohort of osteoarthritic knees and to analyse, in particular, the association of knee alignment and TT–TG.

Methods

Data from 962 consecutive patients [455 male, 507 female; mean age ± SD 70.8 ± 9.3 (37–96)] who had undergone 3D-CT and preoperative knee planning with validated commercial 3D planning software before total knee arthroplasty (TKA) were collected prospectively. The TT–TG, coronal hip knee ankle angle (HKA), femoral anteversion (AVF), external tibial torsion (ETT), and femorotibial rotation (Rot FT) were analysed. Pearson correlations were performed to assess correlations between TT–TG, mechanical axis, and rotational parameters (p < 0.05).

Results

HKA showed a strong correlation with TT–TG (r = 0.488; p < 0.001) with 98 (67.1%) and 45 (30.8%) of valgus knees having respective abnormal and pathological TT–TG values. There were no significant correlations between parameters of rotational alignment (AVF, ETT, Rot FT) and TT–TG. Mean TT–TG was 12.9 ± 5.6 mm, ranging from 0.0 to 33.7 mm. 325 (33.8%) of all patients had abnormal (> 15 mm) and 101 (10.5%) had pathological (> 20 mm) values. A varus alignment was present in 716 (74.4%) of the cases (HKA < − 1.5°), a neutral alignment in 100 (10.4%), and a valgus alignment in 146 (15.2%) (HKA > 1.5°).

Conclusion

A wide variation of TT–TG values in osteoarthritic knees was shown by our results. There was a relevant influence of coronal limb alignment on the TT–TG—the more valgus the higher and more pathological the TT–TG. With the aim of having a more personalised TKA, the individual TT–TG should be taken into account to improve the outcome.

Level of clinical evidence

III. Retrospective cohort study.

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Funding

Statistical analysis was funded by Symbios, Yverdon les Bains, Switzerland.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatoloy, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Bettina Hochreiter & Henrik Behrend

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Michael T. Hirschmann

  3. University of Basel, Basel, Switzerland

    Michael T. Hirschmann

  4. Amsler Consulting, Basel, Switzerland

    Felix Amsler

Authors
  1. Bettina Hochreiter
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  2. Michael T. Hirschmann
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Corresponding author

Correspondence to Henrik Behrend.

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The authors declare that they have no conflict of interest.

Ethical approval

All investigations were conducted in conformity with ethical principles of research and that institutional approval of the human protocol for this investigation was obtained.

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Informed was waived by ethical committee.

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Hochreiter, B., Hirschmann, M.T., Amsler, F. et al. Highly variable tibial tubercle–trochlear groove distance (TT–TG) in osteoarthritic knees should be considered when performing TKA. Knee Surg Sports Traumatol Arthrosc 27, 1403–1409 (2019). https://doi.org/10.1007/s00167-018-5141-x

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  • DOI: https://doi.org/10.1007/s00167-018-5141-x

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