Skip to main content

Advertisement

SpringerLink
Log in

Measurement of tibial tuberosity—trochlear groove distance by MRI: assessment and correction of knee positioning errors

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The tibial tuberosity-trochlear groove (TTTG) distance varies with the position of the knee in the MR or CT scanner. We present and assess a simple method for adjustment of adduction or abduction of the knee.

Materials and methods

MRI of the knee encompassing a three-dimensional (3D) sagittal sequence including ≥ 8 cm of the proximal tibia was analyzed (29 females, 17 males; median age 45 years). Using 3D visualization software, the central longitudinal axis of the proximal tibia (TA) was constructed, and the TTTG distance was measured before and after alignment of the TA. Observer reliability was assessed with inter- and intra-class correlation coefficient (ICC) and Bland-Altman plots.

Results

Adduction of the knee occurred in 26 examinations, mean 2.7° (range 0.0° to 9.4°), and abduction in 20 examinations, mean 2.6° (range 0.0° to 7.2°). Following adjustment, the mean TTTG distance increased 2.4 mm (range 0.0 to 6.7 mm) in the knees positioned in adduction and decreased 2.3 mm when in abduction (range 0.0 to 5.5 mm). The correlation coefficient (r2) between the deviation in adduction and abduction and the difference between TTTG unadjusted and adjusted was r2 = 0.96. ICCs were excellent, but limits of agreement were close to ± 3 mm.

Conclusion

Measurement of the TTTG distance by MRI is influenced by a systematic technique-dependent error caused by knee positioning in adduction or abduction. We suggest a simple method for adjusting the positioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26.

    Article  CAS  Google Scholar 

  2. Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee. 2006;13(1):26–31.

    Article  Google Scholar 

  3. Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG, et al. Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy. 2010;26(7):926–35.

    Article  Google Scholar 

  4. Williams AA, Elias JJ, Tanaka MJ, Thawait GK, Demehri S, Carrino JA, et al. The relationship between tibial tuberosity-trochlear groove distance and abnormal patellar tracking in patients with unilateral patellar instability. Arthroscopy. 2016;32(1):55–61.

    Article  Google Scholar 

  5. Goutallier D, Bernageau J, Lecudonnec B. The measurement of the tibial tuberosity. Patella groove distanced technique and results (author's transl). Rev Chir Orthop Reparatrice Appar Mot. 1978;64(5):423–8.

    CAS  PubMed  Google Scholar 

  6. Brattström H. Shape of the intercondylar groove normally and in recurrent dislocation of patella. Acta OrthopScand. 1964;35(Suppl 68):1–148.

    Google Scholar 

  7. Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):697–704.

    Article  Google Scholar 

  8. Pandit S, Frampton C, Stoddart J, Lynskey T. Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop. 2011;35(12):1799–803.

    Article  Google Scholar 

  9. Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2438–44.

    Article  Google Scholar 

  10. Arendt EA, Dejour D. Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):279–93.

    Article  Google Scholar 

  11. Koeter S, Diks MJ, Anderson PG, Wymenga AB. A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg (Br). 2007;89(2):180–5.

    Article  CAS  Google Scholar 

  12. Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A. Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg (Br). 2010;92(10):1376–80.

    Article  CAS  Google Scholar 

  13. Wilcox JJ, Snow BJ, Aoki SK, Hung M, Burks RT. Does landmark selection affect the reliability of tibial tubercle-trochlear groove measurements using MRI? Clin Orthop Relat Res. 2012;470(8):2253–60.

    Article  Google Scholar 

  14. Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H, et al. What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am. 2015;97(17):1441–8.

    Article  Google Scholar 

  15. Yin L, Chen C, Duan X, Deng B, Xiong R, Wang F, et al. Influence of the image levels of distal femur on the measurement of tibial tubercle-trochlear groove distance--a comparative study. J Orthop Surg Res. 2015;10:174,015-0323-4.

    Google Scholar 

  16. Smith BW, Millar EA, Jones KC, Elias JJ. Variations in tibial tuberosity to trochlear groove and posterior cruciate ligament distances due to tibial external and valgus rotations. J Knee Surg. 2018;31(6):557–61.

    Article  Google Scholar 

  17. Hochreiter B, Hess S, Moser L, Hirschmann MT, Amsler F, Behrend H. Healthy knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2020;28(2):398–406.

    Article  Google Scholar 

  18. Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF. End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc. 2014;22(1):214–8.

    Article  Google Scholar 

  19. Camathias C, Pagenstert G, Stutz U, Barg A, Muller-Gerbl M, Nowakowski AM. The effect of knee flexion and rotation on the tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):2811–7.

    Article  Google Scholar 

  20. Marquez-Lara A, Andersen J, Lenchik L, Ferguson CM, Gupta P. Variability in patellofemoral alignment measurements on MRI: influence of knee position. AJR Am J Roentgenol. 2017;208(5):1097–102.

    Article  Google Scholar 

  21. Yao L, Gai N, Boutin RD. Axial scan orientation and the tibial tubercle-trochlear groove distance: error analysis and correction. AJR Am J Roentgenol. 2014;202(6):1291–6.

    Article  Google Scholar 

  22. Ho CP, James EW, Surowiec RK, Gatlin CC, Ellman MB, Cram TR, et al. Systematic technique-dependent differences in CT versus MRI measurement of the tibial tubercle-trochlear groove distance. Am J Sports Med. 2015;43(3):675–82.

    Article  Google Scholar 

  23. Egund N, Palmer J. Femoral anatomy described in cylindrical coordinates using computed tomography. Acta Radiol Diagn (Stockh). 1984;25(3):209–15.

    Article  CAS  Google Scholar 

  24. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  Google Scholar 

  25. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.

    Article  CAS  Google Scholar 

  26. Edholm P. Anatomic angles determined from two radiographic projections. Instrument description and measurement techniques. Acta Radiol Diagn (Stockh). 1966;(Suppl 259):1–86.

  27. Billing L. Roentgen examination of the proximal femur end in children and adolescents; a standardized technique also suitable for determination of the collum-, anteversion-, and epiphyseal angles; a study of slipped epiphysis and coxa plana. Acta Radiol Suppl. 1954;110:1–80.

    CAS  PubMed  Google Scholar 

  28. Berryman F, Pynsent P, McBryde C. A semi-automated method for measuring femoral shape to derive version and its comparison with existing methods. Int J Numer Method Biomed Eng. 2014;30(11):1314–25.

    Article  CAS  Google Scholar 

  29. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol. 1981;137(1):97–101.

    Article  CAS  Google Scholar 

  30. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol. 1997;168(3):791–4.

    Article  CAS  Google Scholar 

  31. Camp CL, Stuart MJ, Krych AJ, Levy BA, Bond JR, Collins MS, et al. CT and MRI measurements of tibial tubercle-trochlear groove distances are not equivalent in patients with patellar instability. Am J Sports Med. 2013;41(8):1835-40.

  32. 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(6):1348–53.

    Article  Google Scholar 

  33. Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S, et al. 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 oatellofemoral instability. Arthroscopy. 2017;33(11):2026–34.

    PubMed  Google Scholar 

  34. Zhang LK, Wang XM, Niu YZ, Liu HX, Wang F. Relationship between patellar tracking and the "screw-home" mechanism of tibiofemoral joint. Orthop Surg. 2016;8(4):490–5.

    Article  Google Scholar 

  35. Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Sudkamp NP, et al. 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. 2014;22(11):2655–61.

    Article  Google Scholar 

  36. Suomalainen JS, Regalado G, Joukainen A, Kaariainen T, Kononen M, Manninen H, et al. Effects of knee flexion and extension on the tibial tuberosity-trochlear groove (TT-TG) distance in adolescents. J Exp Orthop. 2018;5(1):31,018-0149-1.

    Article  Google Scholar 

Download references

Acknowledgments

Thanks go to research radiographer Olga Vendelbo for supporting the performance of the MR examinations and to research engineer Kennet Sønderstgaard Thorup for statistic help.

Author information

Authors and Affiliations

  1. Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus University Hospital, 8200, Aarhus, Denmark

    Niels Egund, Nikolaj Skou, Bjarke Jacobsen & Anne Grethe Jurik

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Anne Grethe Jurik

Authors
  1. Niels Egund
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolaj Skou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bjarke Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Grethe Jurik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Niels Egund.

Ethics declarations

The study was not externally funded and none of the authors has conflicts of interests to disclose. Patient consent and approval from the Central Denmark Region Committees on Health Research Ethics were waived due to the retrospective design of the study. The data extract was approved by the Data Protection Agency in the Central Denmark Region (protocol number 2012-58-006).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Egund, N., Skou, N., Jacobsen, B. et al. Measurement of tibial tuberosity—trochlear groove distance by MRI: assessment and correction of knee positioning errors. Skeletal Radiol 50, 751–759 (2021). https://doi.org/10.1007/s00256-020-03605-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03605-7

Keywords

Search

Navigation