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Tibial tubercle to trochlear groove distance versus tibial tubercle to posterior cruciate ligament distance for predicting patellar instability: a systematic review

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

To determine the reliability and diagnostic accuracy of tibial tubercle–trochlear groove (TT–TG) distance versus tibial tubercle–posterior cruciate ligament (TT–PCL) distance, and to determine cutoff values of these measurements for pathological diagnosis in the context of patellar instability.

Methods

Three databases MEDLINE, PubMed and EMBASE were searched from inception to October 5, 2022 for literature outlining comparisons between TT–TG and TT–PCL in patellar instability patients. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on inter-rater and intra-rater reliability, receiver-operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, as well as odds ratios, cutoff values for pathological diagnosis and correlations between TT–TG and TT–PCL were recorded. The MINORS score was used for all studies in order to perform a quality assessment of included studies.

Results

A total of 23 studies comprising 2839 patients (2922 knees) were included in this review. Inter-rater reliability ranged from 0.71 to 0.98 and 0.55 to 0.99 for TT–TG and TT–PCL, respectively. Intra-rater reliability ranged from 0.74 to 0.99 and 0.88 to 0.98 for TT–TG and TT–PCL, respectively. AUC measuring diagnostic accuracy of patellar instability for TT–TG ranged from 0.80 to 0.84 and 0.58 to 0.76 for TT–PCL. Five studies found TT–TG to have more discriminatory power than TT–PCL at distinguishing patients with patellar instability from patients who do not. Sensitivity and specificity ranged from 21 to 85% and 62 to 100%, respectively, for TT–TG. Sensitivity and specificity ranged from 30 to 76% and 46 to 86%, respectively, for TT–PCL. Odds ratio values ranged from 1.06 to 14.02 for TT–TG and 0.98 to 6.47 for TT–PCL. Proposed cutoff TT–TG and TT–PCL values for predicting patellar instability ranged from 15.0 to 21.4 mm and 19.8 to 28.0 mm, respectively. Eight studies reported significant positive correlations between TT–TG and TT–PCL.

Conclusion

TT–TG resulted in overall similar reliability, sensitivity and specificity as TT–PCL; however, TT–TG has better diagnostic accuracy than TT–PCL in the context of patellar instability as per AUC and odds ratio values.

Level of evidence

Level IV.

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Fig. 1

Data availability

Raw data is available upon request at prushoth.vivekanantha@medportal.ca.

Abbreviations

MPFL:

Medial patellofemoral ligament

MPFLR:

Medial patellofemoral ligament reconstruction

TTO:

Tibial tubercle osteotomy

TT–TG:

Tibial tubercle–trochlear groove

TT–PCL:

Tibial tubercle–posterior cruciate ligament

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

R-AMSTAR:

Revised assessment of multiple systematic reviews

ICC:

Intraclass correlation coefficient

MINORS:

Methodological Index for Non-Randomised Studies

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

MRI:

Magnetic resonance imaging

CT:

Computed tomography

TW:

Trochlear width

PW:

Patellar width

TPW:

Tibial plateau width

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Authors and Affiliations

  1. Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Prushoth Vivekanantha

  2. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Harjind Kahlon

  3. University Health Network, University of Toronto, Toronto, ON, Canada

    Ali Shahabinezhad

  4. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada

    Dan Cohen & Darren de SA

  5. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Kanto Nagai & Yuichi Hoshino

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Vivekanantha, P., Kahlon, H., Shahabinezhad, A. et al. Tibial tubercle to trochlear groove distance versus tibial tubercle to posterior cruciate ligament distance for predicting patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07358-3

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Keywords

  • TT–TG
  • TT–PCL
  • Patellar dislocation
  • Diagnostic accuracy
  • Reliability