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Higher pathologic threshold of increased tibial tuberosity–trochlear groove distance should be considered for taller patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate the correlation between tibial tuberosity–trochlear groove distance (TT–TG) and body height or knee size, and to find height-related pathologic thresholds of increased TT–TG.

Methods

One-hundred and fifty-three patients with recurrent patellar instability and 151 controls were included. The TT–TG was measured on axial computed tomography (CT) images. Femora width and tibial width were selected to represent knee size. The correlation of TT–TG and gender, body height, femora width, and tibial width was evaluated. The height-related pathologic threshold of increased TT–TG was produced according to Dejour’s method. To combine TT–TG with body height and knee size, three new indexes were introduced, ratio of TT–TG to body height (RTH), ratio of TT–TG to femoral width (RTF), and ratio of TT–TG to tibial width (RTT). The ability to predict patellar instability was assessed by the receiver-operating characteristic (ROC) curve, odds ratios (ORs), sensitivity, and specificity.

Results

In patients with patellar instability, TT–TG showed significantly correlation with patient height, femoral width, and tibial width respectively (range r = 0.266–0.283). This correlation was not found in the control group. The pathologic threshold of TT–TG was 18 mm in patients < 169 cm (53%), and the mean TT–TG was 21 mm in patients ≥ 169 cm (54%). There was significant difference in RTH, RTF, and RTT between the two groups. RTH, RTF and RTT have similar large area under the curve (AUC) with TT–TG.

Conclusions

TT–TG showed significant correlation with body height and knee size, respectively. The pathologic threshold of increased TT–TG was suggested to be 21 mm for patients \(\ge\) 169 cm and 18 mm for patients \(<\) 169 cm. Body height-related pathologic threshold provided a supplement for indications of tibial tuberosity medialization.

Level of evidence

IV.

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Funding

This work was supported by the National Natural Science Foundation of China (Grant Nos. 51773004, 81630056, 51920105006, 51803188, and 31670982) and National Key Research and Development Program (Grant No. 2016YFC1100704).

Author information

Authors and Affiliations

  1. Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People’s Republic of China

    Hai-Jun Wang, Yi-Fan Song, Yong Ma, Lin Lin, Jian Wang, Yong-Jian Wang, Yang Liu & Jia-Kuo Yu

  2. Department of Sports Medicine, First Affiliated Hospital, Shenzhen University, Shenzhen, 518000, China

    Wei Lu

  3. Department of Joint Surgery, Hebei Medical University, Third Affiliated Hospital, No.139 Ziqiang Road, Shijiazhuang, 050000, China

    Fei Wang

  4. Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People’s Republic of China

    Hai-Jun Wang, Yi-Fan Song, Yong Ma, Lin Lin, Jian Wang, Yong-Jian Wang, Yang Liu & Jia-Kuo Yu

Authors
  1. Hai-Jun Wang
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  2. Yi-Fan Song
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  3. Yong Ma
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  4. Lin Lin
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  5. Jian Wang
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  6. Yong-Jian Wang
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  7. Yang Liu
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  8. Wei Lu
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  9. Fei Wang
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  10. Jia-Kuo Yu
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Contributions

Conception and design of the study: H-JW. Acquisition of data: Y-FS, YM, LL, and JW. Analysis, or interpretation of data: Y-JW, YL, and WL. Drafting the work: H-JW and Y-FS. Revising it critically for important intellectual content: J-KY and FW. Final approval of the version to be published: H-JW, Y-FS, YM, LL, JW, Y-JW, YL, WL, FW, and J-KY. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: H-JW, Y-FS, YM, LL, JW, Y-JW, YL, WL, FW, and J-KY.

Corresponding authors

Correspondence to Fei Wang or Jia-Kuo Yu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of Peking University Third Hospital. (Project Number: 2014099).

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Informed consent was obtained from all individual participants included in the study.

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Wang, HJ., Song, YF., Ma, Y. et al. Higher pathologic threshold of increased tibial tuberosity–trochlear groove distance should be considered for taller patients. Knee Surg Sports Traumatol Arthrosc 30, 3760–3766 (2022). https://doi.org/10.1007/s00167-022-06992-7

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  • DOI: https://doi.org/10.1007/s00167-022-06992-7

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