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Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females

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The aim of this study was to report normal values of the tibial tuberosity–trochlear groove distance (TTTG) in males and females and assess the reliability of MRI in measuring TTTG.


Patients presenting with a suspected meniscus injury without any patellofemoral or ligamentous instability, and arthroscopically normal cruciate ligaments and patellofemoral joints were included in the study. K-PACS© was used for MRI analysis and was performed by three observers blinded to each others’ measurements.


One hundred patients (57 males, 43 females) were recruited from 2006–2010. The mean TTTG in males was 9.91 mm (95% CI 8.9–10.8 mm) and in females 10.04 mm (95% CI 8.9–11.1). The coefficient of variation was <10% for both intra and inter-observer analysis.


The normal TTTG distance is 10 ± 1 mm with MRI being a reliable method of measurement. Literature supports a high degree of variability in reporting TTTG. This study establishes normal TTTG values, which will help in the assessment and treatment of patellofemoral disorders.

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  1. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26

    Article  PubMed  CAS  Google Scholar 

  2. 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(10):597–601

    Article  PubMed  CAS  Google Scholar 

  3. Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC (2006) Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 22(6):643–649

    Article  PubMed  Google Scholar 

  4. Alemparte J, Ekdahl M, Burnier L, Hernández R, Cardemil A, Cielo R, Danilla S (2007) Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy 23(2):170–177

    Article  PubMed  Google Scholar 

  5. Lustig S, Servien E, Aït Si Selmi T, Neyret P (2006) Factors affecting reliability of TT-TG measurements before and after medialization: A CT-scan study. Rev Chir Orthop Reparatrice Appar Mot 92(5):429–436

    Article  PubMed  CAS  Google Scholar 

  6. Saudan M, Fritschy D (2000) AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86(3):250–255

    PubMed  CAS  Google Scholar 

  7. Wittstein JR, O’Brien SD, Vinson EN, Garrett WE Jr (2009) MRI evaluation of anterior knee pain: predicting response to nonoperative treatment. Skeletal Radiol 38(9):895–901

    Article  PubMed  Google Scholar 

  8. Hendricks WA, Robey KW (Ann.91936) The sampling distribution of the coefficient of variation. Math Statist 129–132

  9. Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428

    PubMed  CAS  Google Scholar 

  10. Wagenaar FC, Koëter S, Anderson PG, Wymenga AB (2007) Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation. Knee 14(1):51–54

    Article  PubMed  Google Scholar 

  11. Shakespeare D, Fick D (2005) Patellar instability-can the TT-TG distance be measured clinically? Knee 12(3):201–204

    Article  PubMed  Google Scholar 

  12. Dejour H, Walch G, Neyret P, Adeleine P (1990) La dysplasie de la trochlee femorale. Rev Chir Orthop 76:45–54

    PubMed  CAS  Google Scholar 

  13. Smith TO, Davies L, Toms AP, Hing CB, Donell ST (2010) The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis. Skeletal Radiol [Epub ahead of print]

  14. 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(1):26–31

    Article  Google Scholar 

  15. Stäubli HU, Dürrenmatt U, Porcellini B, Rauschning W (1999) Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone Joint Surg Br 81(3):452–458

    Article  PubMed  Google Scholar 

  16. Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop Relat Res 115:225–230

    PubMed  Google Scholar 

  17. Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90(2):180–185

    Article  PubMed  CAS  Google Scholar 

  18. Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: A minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76(5):693–698

    Article  PubMed  Google Scholar 

  19. DeJour D, Saggin P (2010) The sulcus deepening trochleoplasty—the Lyon’s procedure. Int Orthop 34:311–316

    Article  PubMed  Google Scholar 

  20. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23(5):542–553

    Article  PubMed  Google Scholar 

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Correspondence to Salil Pandit.

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Pandit, S., Frampton, C., Stoddart, J. et al. Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females. International Orthopaedics (SICOT) 35, 1799–1803 (2011).

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