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Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions



To evaluate the variation in tibial tubercle sagittal alignment in patients with and without patellofemoral (PF) cartilage wear.


This was a single-centre, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014 to 2020. Patients were matched in a 1:2 ratio for age, sex and BMI to partial meniscectomy patients as controls. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle.


One hundred and forty patients (47 cartilage restoration, 94 meniscectomy) were included. Mean age, BMI, and height for the total cohort were 34.01 ± 8.7, 26.6 ± 6.4, and 173.0 ± 17.7 respectively, with 78 males (55%) and 63 females (45%). There were no significant differences between groups for age, BMI or sex (n.s). The cartilage restoration group (− 2.5 mm ± 5.9) was found to have a significantly more posterior (negative) sTT-TG compared to the meniscectomy group (1.72 mm ± 6.7) (p < 0.001). Interrater reliability was excellent (ICC = 0.931, p < 0.001). Patients with less than − 3.4 mm sTT-TG were 2.74 times more likely to have a cartilage restoration procedure compared to those with greater than − 3.4 mm (OR 2.7, 95% CI 1.3–5.85). Patients with < − 10 mm posterior translation were 13.7× (CI 1.6–111.1) more likely to have a cartilage restoration procedure.


Patients that underwent isolated cartilage restoration procedures had a significantly more posterior tibial tubercle than partial meniscectomy controls based on the sagittal TT-TG. The more posterior the tubercle, the more likely the patient had a cartilage restoration procedure. Surgeons should consider the sTT-TG measurement in patients presenting with anterior knee pain, particularly patellofemoral lesions.

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Correspondence to Daniel J. Kaplan.

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The design and protocol were approved by the New York University Langone Medical Center institutional review board, IRB# 19-01430.

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Kaplan, D.J., Mojica, E.S., Ortega, P.F. et al. Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions. Knee Surg Sports Traumatol Arthrosc (2022).

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  • Sagittal tibial tubercle-trochlear groove distance
  • sTT-TG
  • Patellofemoral cartilage injury
  • Patellofemoral cartilage repair
  • Tibial tubercle osteotomy