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The tibial tubercle–posterior cruciate ligament (TT–PCL) distance does not truly reflect the lateralization of the tibial tubercle



The role of the tibial tubercle–posterior cruciate ligament (TT–PCL) and tibial tubercle–trochlear groove (TT–TG) in recurrent patellar instability (RPI) remains unclear. This study aims to confirm the validity of the TT–TG and TT–PCL in predicting RPI and to verify whether the TT–PCL can truly reflect the lateralization of the tibial tubercle.


A total of 50 patients with RPI and 50 controls were recruited and underwent magnetic resonance imaging examinations. The TT–TG, TT–PCL, and tibial tubercle lateralization (TTL) were measured independently by two authors in a blinded and randomized fashion. T-test was used for parametric variances and the Mann–Whitney U and Chi-square tests were used for non-parametric variances. Pearson’s product moment correlation coefficients were calculated to determine correlations between the defined measurements. The intraclass correlation coefficient was used to assess the reliability of the measurements.


All defined measurements showed excellent intra- and inter-observer reliability. The TT–TG distance, TT–PCL distance, and TTL were significantly greater in the PI group than in the control group. The AUC was highest for the TT–TG distance compared with that for the TT–PCL distance, and TTL were 0.798, 0.764, and 0.769, with the calculated cut-off value of 12.5 mm, 16.5 mm, and 66.1 percentages. There was a moderate correlation (r = 0.595) between the TT–TG distance and TTL, and a weak correlation (r = 0.430) between the TT–PCL distance and TTL.


Both the TT–TG distance and TT–PCL distance can be measured with excellent reliability on magnetic resonance imaging. The TT–TG distance, rather than the TT–PCL distance, has a better performance in predicting RPI. Most interestingly, the TT–PCL distance cannot reflect the real lateralization of TT. This study provides new information to evaluate TTL in patients with RPI.

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We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.


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Correspondence to Fei Wang.

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Dong, Z., Zhang, X., Xu, C. et al. The tibial tubercle–posterior cruciate ligament (TT–PCL) distance does not truly reflect the lateralization of the tibial tubercle. Knee Surg Sports Traumatol Arthrosc 30, 3470–3479 (2022).

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  • Tibial tubercle–trochlear groove (TT–TG)
  • Tibial tubercle–posterior cruciate ligament (TT–PCL)
  • Patellar instability
  • Tibial tubercle lateralization