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The effect of native knee rotation on the tibial-tubercle-trochlear-groove distance in patients with patellar instability: an analysis of MRI and CT measurements

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

This study aimed to quantify the effect of lower limb rotational parameters on the difference in the tibial-tubercle-trochlear-groove (TTTG) distance when assessed with magnetic resonance imaging (MRI) and computed tomography (CT) in patients with patellar instability. It was hypothesized that an increased native knee rotation angle significantly contributes to an underestimation of TTTG by MRI.

Methods

Forty patients with patellar instability who had undergone standard radiographs, MRI and CT scans were included in this retrospective study. A musculoskeletal radiologist assessed all imaging for TTTG, femoral and tibial rotation, knee rotation and flexion angle, and trochlear dysplasia. ΔTTTG was defined as the TTTG measured on MRI subtracted from the TTTG measured on CT. Statistical analysis determined the effect of these parameters on the calculated difference between TTTG when measured on CT and MRI.

Results

Equal knee flexion in MRI and CT resulted in a ΔTTTG of 0.1 ± 0.3 mm compared to 4.0 ± 3.3 mm in patients with different knee flexion angles in both imaging acquisitions (p = 0.036). The knee rotation angle measured on CT (native knee rotation angle) was negatively correlated with ΔTTTG (r = − 0.365; p = 0.002), while neither tibial nor femoral rotation showed any associations with TTTG (n.s.). Trochlear dysplasia did not show any significant correlation with ΔTTTG, regardless of classification by Dejour or Lippacher (n.s.). Both the native knee rotation angle and the MRI knee flexion angle were independent predictors of ΔTTTG, yet with an opposing effect (knee rotation: 95% Confidence Interval [CI] for β − 0.468 to − 0.154, p < 0.001; knee flexion 95% CI for β 0.292 to 0.587, p < 0.001). Patients with a native knee rotation angle > 20° showed a ΔTTTG of − 5.8 ± 4.0 mm (MRI rather overestimates TTTG) compared to 0.9 ± 4.1 mm Δ TTTG (MRI rather underestimates TTTG) in patients with < 20° native knee rotation angle.

Conclusion

The native knee rotation angle is an independent, inversely correlated predictor of ΔTTTG, thus opposing the effect of knee flexion during MRI acquisition. Consequently, these results suggest that not only knee flexion but also knee rotation should be appreciated when assessing TTTG during patellar instability diagnostic evaluation as it can potentially lead to a false estimation of the TTTG distance on MRI.

Level of evidence

Level III

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References

  1. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  Google Scholar 

  2. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41:374–384

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  4. Monk AP, Doll HA, Gibbons CL, Ostlere S, Beard DJ, Gill HS et al (2011) The patho-anatomy of patellofemoral subluxation. J Bone Joint Surg Br 93:1341–1347

    Article  CAS  Google Scholar 

  5. Balcarek P, Jung K, Ammon J, Walde TA, Frosch S, Schuttrumpf JP et al (2010) Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 38:2320–2327

    Article  Google Scholar 

  6. Balcarek P, Jung K, Frosch KH, Sturmer KM (2011) Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39:1756–1761

    Article  Google Scholar 

  7. Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT (2017) The tibial tubercle-trochlear groove distance is greater in patients with patellofemoral pain: implications for the origin of pain and clinical interventions. Am J Sports Med 45:1110–1116

    Article  Google Scholar 

  8. 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 64:423–428

    CAS  PubMed  Google Scholar 

  9. Tan SHS, Lim BY, Chng KSJ, Doshi C, Wong FKL, Lim AKS et al (2020) The difference between computed tomography and magnetic resonance imaging measurements of tibial tubercle-trochlear groove distance for patients with or without patellofemoral instability: a systematic review and meta-analysis. J Knee Surg 33:768–776

    Article  Google Scholar 

  10. Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22:214–218

    Article  Google Scholar 

  11. Camp CL, Stuart MJ, Krych AJ, Levy BA, Bond JR, Collins MS et al (2013) CT and MRI measurements of tibial tubercle-trochlear groove distances are not equivalent in patients with patellar instability. Am J Sports Med 41:1835–1840

    Article  Google Scholar 

  12. Wilcox JJ, Snow BJ, Aoki SK, Hung M, Burks RT (2012) Does landmark selection affect the reliability of tibial tubercle-trochlear groove measurements using MRI? Clin Orthop Relat Res 470:2253–2260

    Article  Google Scholar 

  13. Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981

    Article  Google Scholar 

  14. Koeter S, Diks MJ, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 89:180–185

    Article  CAS  Google Scholar 

  15. Dornacher D, Trubrich A, Guelke J, Reichel H, Kappe T (2017) Evaluation of a modified knee rotation angle in MRI scans with and without trochlear dysplasia: a parameter independent of knee size and trochlear morphology. Knee Surg Sports Traumatol Arthrosc 25:2447–2452

    Article  Google Scholar 

  16. Prakash J, Seon JK, Ahn HW, Cho KJ, Im CJ, Song EK (2018) Factors affecting tibial tuberosity-trochlear groove distance in recurrent patellar dislocation. Clin Orthop Surg 10:420–426

    Article  Google Scholar 

  17. Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H et al (2015) What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am 97:1441–1448

    Article  Google Scholar 

  18. Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J et al (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843

    Article  Google Scholar 

  19. 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 13:26–31

    Article  Google Scholar 

  20. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69:1169–1176

    Article  CAS  Google Scholar 

  21. Goutallier D, Van Driessche S, Manicom O, Sariali E, Bernageau J, Radier C (2006) Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am 88:2439–2447

    Article  Google Scholar 

  22. Duerr RA, Chauhan A, Frank DA, DeMeo PJ, Akhavan S (2016) An algorithm for diagnosing and treating primary and recurrent patellar instability. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.15.00102

    Article  PubMed  Google Scholar 

  23. Camathias C, Pagenstert G, Stutz U, Barg A, Muller-Gerbl M, Nowakowski AM (2016) The effect of knee flexion and rotation on the tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 24:2811–2817

    Article  Google Scholar 

  24. Hamai S, Moro-oka TA, Miura H, Shimoto T, Higaki H, Fregly BJ et al (2009) Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities. J Orthop Res 27:1555–1561

    Article  Google Scholar 

  25. Nagao N, Tachibana T, Mizuno K (1998) The rotational angle in osteoarthritic knees. Int Orthop 22:282–287

    Article  CAS  Google Scholar 

  26. Piazza SJ, Cavanagh PR (2000) Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment. J Biomech 33:1029–1034

    Article  CAS  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Jakob Ackermann, Julian Hasler, Sandro F. Fucentese & Lazaros Vlachopoulos

  2. Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland

    Dimitri Nicolas Graf

Authors
  1. Jakob Ackermann
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  2. Julian Hasler
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  3. Dimitri Nicolas Graf
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  4. Sandro F. Fucentese
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  5. Lazaros Vlachopoulos
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jakob Ackermann, Julian Hasler and Dimitri Graf. The first draft of the manuscript was written by Jakob Ackermann and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jakob Ackermann.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Swiss Ethics Committee (# 2020-01052).

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Ackermann, J., Hasler, J., Graf, D.N. et al. The effect of native knee rotation on the tibial-tubercle-trochlear-groove distance in patients with patellar instability: an analysis of MRI and CT measurements. Arch Orthop Trauma Surg 142, 3149–3155 (2022). https://doi.org/10.1007/s00402-021-03947-4

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  • DOI: https://doi.org/10.1007/s00402-021-03947-4

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