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Comparison of post-operative outcomes following anterior cruciate ligament reconstruction between patients with vs. without elevated tibial tubercle–trochlear groove (TT–TG) distance

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It is unclear if an elevated tibial tubercle–trochlear groove (TT–TG) distance is a risk factor for poor outcomes following ACLR. Therefore, the purpose of this study was to determine whether patients with an elevated TT–TG have an increased risk of retear following primary ACLR compared to controls with a normal TT–TG.

Methods

All patients who underwent primary ACLR between July 2018 and June 2019 with an available preoperative magnetic resonance imaging (MRI) were eligible for inclusion. TT–TG distance was measured on preoperative MRI scans by two independent investigators. Clinical outcomes, return-to-sport rates, and Lysholm scores were compared between patients with a TT–TG < 12.5 mm (normal) and those with a TT–TG ≥ 12.5 mm (elevated).

Results

Overall, 159 patients were included, 98 with normal TT–TG distance and 61 with elevated TT–TG distance. Patients with an elevated TT–TG distance had worse post-operative Lysholm scores than patients with a normal TT–TG distance (83.0 vs. 95.0, p = 0.010). In patients who received a bone–patellar tendon–bone (BTB) graft, an elevated TT–TG distance was associated with higher rates of subjective instability (13.0% vs. 3.0%, p = 0.041), reoperation (13.0% vs. 1.5%, p = 0.012), and post-operative complications (25.0% vs. 8.2%, p = 0.026), as well as lower ACL psychological readiness scores (324.1 vs. 446.7, p = 0.015).

Conclusion

Patients with an elevated pre-operative TT–TG distance have worse Lysholm scores than patients with normal TT–TG distance. Patients with an elevated pre-operative TT–TG distance who underwent ACLR with BTB grafts had significantly higher rates of subjective instability, reoperation, and post-operative complications.

Level of evidence

III.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Rothman Orthopaedic Institute, Philadelphia, PA, US

    Ryan W. Paul, Emma E. Johnson, Michael G. Ciccotti & Steven B. Cohen

  2. Rothman Orthopaedic Institute, Egg Harbor Township, NJ, US

    Anya Hall

  3. Sidney Kimmel Medical College, Philadelphia, PA, US

    Ari Clements

  4. Rothman Orthopaedic Institute, 645 Madison Avenue 3rd and 4th floors, New York, NY, 10022, US

    Meghan E. Bishop & Brandon J. Erickson

Authors
  1. Ryan W. Paul
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  2. Emma E. Johnson
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  4. Ari Clements
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  6. Michael G. Ciccotti
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  7. Steven B. Cohen
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  8. Brandon J. Erickson
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Contributions

RWP, MEB, MGC, SBC, and BJE were responsible for research design. RWP, EEJ, AH, and AC identified and screened eligible patients. RWP and EEJ measured TT–TG distances. RWP, EEJ, AH, and AC contacted patients for follow-up. RWP was responsible for data analysis and interpretation. RWP was responsible for writing, with guidance and help from all other authors. All authors contributed significant edits to the paper. All authors gave approval of the final submitted version.

Corresponding author

Correspondence to Brandon J. Erickson.

Ethics declarations

Conflict of interest

Ryan Paul: none. Emma Johnson: none. Anya Hall: none. Ari Clements: none. Meghan Bishop: education fees and grant funding from Arthrex Inc. Hospitality fees from Stryker Corporation. Education fees from Smith & Nephew Inc. Education fees from Gotham Surgical Solutions & Devices, Inc. Michael Ciccotti: American Orthopaedic Society for Sports Medicine: board or committee member. Major League Baseball Team Physicians Association: board or committee member. Orthopaedic Learning Center: board or committee member. Steven Cohen: American Orthopaedic Society for Sports Medicine: board or committee member. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Arthrex, Inc: research support. Major League Baseball: research support. CONMED Linvatec: paid consultant. Slack, INC: publishing royalties, financial or material support. Zimmer: IP royalties; paid consultant; paid presenter or speaker. Brandon Erickson: AAOS: board or committee member. American Orthopaedic Society for Sports Medicine: board or committee member. American Shoulder and Elbow Surgeons: board or committee member. PLOS One: editorial or governing board. Arthrex, Inc: paid consultant; research support. DePuy, A Johnson & Johnson Company: research support. Linvatec: research support. Smith & Nephew: research support. Stryker: research support.

Ethical approval

This study was approved by the institutional review board (Thomas Jefferson University #21E.511).

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Appendix

Appendix

See Tables 4, 5, 6.

Table 4 Frequency of post-complications between normal (< 12.5 mm) and elevated (≥ 12.5 mm) tibial tubercle–trochlear groove (TT–TG) distance patients
Full size table
Table 5 Frequency of post-complications between athletes with normal (< 12.5 mm) and elevated (≥ 12.5 mm) tibial tubercle–trochlear groove (TT–TG) distance
Full size table
Table 6 Frequency of post-complications between bone–patellar tendon–bone (BTB) graft patients with normal (< 12.5 mm) and elevated (≥ 12.5 mm) tibial tubercle–trochlear groove (TT–TG) distance
Full size table

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Paul, R.W., Johnson, E.E., Hall, A. et al. Comparison of post-operative outcomes following anterior cruciate ligament reconstruction between patients with vs. without elevated tibial tubercle–trochlear groove (TT–TG) distance. Knee Surg Sports Traumatol Arthrosc 31, 2446–2453 (2023). https://doi.org/10.1007/s00167-022-07191-0

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  • DOI: https://doi.org/10.1007/s00167-022-07191-0

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