Skip to main content
Log in

The position of the tibia tubercle in 0°–90° flexion: comparing patients with patella dislocation to healthy volunteers

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to measure the tibia tubercle trochlea groove distance (TT–TG) as a function of knee flexion. Our hypothesis was that there is a different pattern in healthy volunteers and patients with patella instability (PFI).

Methods

Thirty-six knees of 30 patients with at least one dislocation of the patella and 30 knees of 30 healthy volunteers as control group were analysed with magnetic resonance imaging by three different observers. The TT–TG was measured in steps of 15° between 0° and 90° of knee flexion. Furthermore, the alignment of the leg (MA), the femur torsion (FTor) and the tibia torsion (TTor) was calculated.

Results

The TT–TG was higher in patients compared to volunteers and in extension compared to flexion. This difference was statistically significant (p < 0.05). Most of the patients with a TT–TG above 20 mm in extension showed a high decrease in flexion to normal values. In some patients, this compensating mechanism fails. MA, FTor and TTor were not different in patients and control group (n.s.).

Conclusion

The TT–TG distance is dynamic and decreased significantly during flexion in knees with PFI and healthy volunteers. However, there were a small number of patients in the PFI group where this compensation mechanism did not work. Therefore, the decision to perform a tibia tubercle osteotomy should not be based on one single measurement in extension or 30° of knee flexion.

Level of evidence

II.

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

Access this article

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

Similar content being viewed by others

References

  1. Biedert RM, Gruhl C (1997) Axial computed tomography of the patellofemoral joint with and without quadriceps contraction. Arch Orthop Trauma Surg 116:77–82

    Article  PubMed  CAS  Google Scholar 

  2. Bland JM, Altman DG (1995) Multiple significance tests: the Bonferroni method. Br Med J 310:170

    Article  CAS  Google Scholar 

  3. Caplan N, Lees D, Newby M, Ewen A, Jackson R, St Clair GA, Kader D (2014) Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2954-0

    PubMed  Google Scholar 

  4. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Diederichs G, Kohlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57

    Article  PubMed  Google Scholar 

  7. Galland O, Walch G, Dejour H, Carret JP (1990) An anatomical and radiological study of the femoropatellar articulation. Surg Radiol Anat 12:119–125

    Article  PubMed  CAS  Google Scholar 

  8. Iranpour F, Merican AM, Baena FR, Cobb JP, Amis AA (2010) Patellofemoral joint kinematics: the circular path of the patella around the trochlear axis. J Orthop Res 28:589–594

    PubMed  Google Scholar 

  9. Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Sudkamp 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. doi:10.1007/s00167-013-2537-5

    PubMed  Google Scholar 

  10. Kalichman L, Zhang Y, Niu J, Goggins J, Gale D, Felson DT, Hunter D (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features–an MRI study. Rheumatology (Oxford) 46:1303–1308

    Article  CAS  Google Scholar 

  11. Koeter S, Diks MJ, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 89:180–185

    Article  PubMed  CAS  Google Scholar 

  12. Kuroda R, Kambic H, Valdevit A, Andrish JT (2001) Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J Sports Med 29:403–409

    PubMed  CAS  Google Scholar 

  13. Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nagamine R, Miura H, Inoue Y, Tanaka K, Urabe K, Okamoto Y, Nishizawa M, Iwamoto Y (1997) Malposition of the tibial tubercle during flexion in knees with patellofemoral arthritis. Skeletal Radiol 26:597–601

    Article  PubMed  CAS  Google Scholar 

  15. Sasaki T, Yagi T (1986) Subluxation of the patella. Investigation by computerized tomography. Int Orthop 10:115–120

    Article  PubMed  CAS  Google Scholar 

  16. Schneider B, Laubenberger J, Jemlich S, Groene K, Weber HM, Langer M (1997) Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol 70:575–579

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125

    Article  PubMed  Google Scholar 

  19. Servien E, Verdonk PC, Neyret P (2007) Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc 15:61–67

    Article  PubMed  Google Scholar 

  20. Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J, Bach BR, Cole BJ (2013) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med. doi:10.1177/0363546513507423

    Google Scholar 

  21. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ (1997) MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. Am J Roentgenol 168:791–794

    Article  CAS  Google Scholar 

  22. Yamada Y, Toritsuka Y, Horibe S, Sugamoto K, Yoshikawa H, Shino K (2007) In vivo movement analysis of the patella using a three-dimensional computer model. J Bone Joint Surg Br 89:752–760

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerd Seitlinger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seitlinger, G., Scheurecker, G., Högler, R. et al. The position of the tibia tubercle in 0°–90° flexion: comparing patients with patella dislocation to healthy volunteers. Knee Surg Sports Traumatol Arthrosc 22, 2396–2400 (2014). https://doi.org/10.1007/s00167-014-3173-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3173-4

Keywords

Navigation