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Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative

  • Musculoskeletal
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Abstract

Objectives

To determine whether the tibial tuberosity-to-trochlear groove (TT-TG) distance is associated with concurrent patellofemoral joint osteoarthritis (OA)-related structural damage and its worsening on 24-month follow-up magnetic resonance imaging (MRI) in participants in the Osteoarthritis Initiative (OAI).

Methods

Six hundred subjects (one index knee per participant) were assessed. To evaluate patellofemoral OA-related structural damage, baseline and 24-month semiquantitative MRI Osteoarthritis Knee Score (MOAKS) variables for cartilage defects, bone marrow lesions (BMLs), osteophytes, effusion, and synovitis were extracted from available readings. The TT-TG distance was measured in all subjects using baseline MRIs by two musculoskeletal radiologists. The associations between baseline TT-TG distance and concurrent baseline MOAKS variables and their worsening in follow-up MRI were investigated using regression analysis adjusted for variables associated with tibiofemoral and patellofemoral OA.

Results

At baseline, increased TT-TG distance was associated with concurrent lateral patellar and trochlear cartilage damages, BML, osteophytes, and knee joint effusion [cross-sectional evaluations; overall odds ratio 95% confidence interval (OR 95% CI): 1.098 (1.045–1.154), p < 0.001]. In the longitudinal analysis, increased TT-TG distance was significantly related to lateral patellar and trochlear cartilage, BML, and joint effusion worsening (overall OR 95% CI: 1.111 (1.056–1.170), p < 0.001).

Conclusions

TT-TG distance was associated with simultaneous lateral patellofemoral OA-related structural damage and its worsening over 24 months. Abnormally lateralized tibial tuberosity may be considered as a risk factor for future patellofemoral OA worsening.

Key Points

• Excessive TT-TG distance on MRI is an indicator/predictor of lateral-patellofemoral-OA.

• TT-TG is associated with simultaneous lateral-patellofemoral-OA (6–17% chance-increase for each millimeter increase).

• TT-TG is associated with longitudinal (24-months) lateral-patellofemoral-OA (5–15% chance-increase for each millimeter).

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Abbreviations

2D:

Two-dimensional

ACL:

Anterior cruciate ligament

ANOVA:

Analysis of variance

AUC:

Area under the curve

BMI:

Body mass index

BML:

Bone marrow lesion

CI:

Confidence interval

CT:

Computed tomography

DESS:

Dual echo at steady state

FNIH:

Foundation for the National Institute of Health

IW:

Intermediate weighted

JSL:

Joint space loss

KL:

Kellgren-Lawrence

MOAKS:

Magnetic resonance imaging osteoarthritis knee score

MPR:

Multiplanar reconstruction

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

OAI:

Osteoarthritis initiative

OR:

Odds ratio

PASE:

Physical activity scale for elderly

ROC:

Receiver-operating characteristic

SD:

Standard deviation

TSE:

Turbo spin echo

TTM:

Tibial tuberosity medialization (TTM)

TT-TG:

Tibial tuberosity trochlear groove

WE:

Water excitation

WOMAC:

Western Ontario & McMaster Universities osteoarthritis index

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 4240, Baltimore, MD, 21287, USA

    Arya Haj-Mirzaian & Shadpour Demehri

  2. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Ali Guermazi & Frank W. Roemer

  3. Department of Radiology, Florida Hospital, Maitland, FL, USA

    Michael Hakky

  4. Department of Radiology, University of Massachusetts Medical School, Boston, MA, USA

    Christopher Sereni

  5. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MA, USA

    Bashir Zikria, Miho J. Tanaka & Andrew J. Cosgarea

  6. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany

    Frank W. Roemer

Authors
  1. Arya Haj-Mirzaian
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  2. Ali Guermazi
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  3. Michael Hakky
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  4. Christopher Sereni
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  5. Bashir Zikria
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  6. Frank W. Roemer
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  7. Miho J. Tanaka
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  9. Shadpour Demehri
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Corresponding author

Correspondence to Arya Haj-Mirzaian.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Shadpour Demehri.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because we used the open access OAI database. All enrolled subjects in OAI study gave informed consent.

Ethical approval

Institutional Review Board approval was not required because we used the open access OAI database.

The OAI study has received ethics board approval by the institutional review board at the University of California, San Francisco (OAI Coordinating Center; Approval Number: 10-00532).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the OAI database and OAI-related articles.

Methodology

• prospective

• observational

• multicenter study

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Haj-Mirzaian, A., Guermazi, A., Hakky, M. et al. Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Eur Radiol 28, 4669–4680 (2018). https://doi.org/10.1007/s00330-018-5460-9

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  • DOI: https://doi.org/10.1007/s00330-018-5460-9

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