J Knee Surg 2020; 33(08): 768-776
DOI: 10.1055/s-0039-1688563
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Si Heng Sharon Tan
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
Beatrice Ying Lim
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
Kiat Soon Jason Chng
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
Chintan Doshi
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
Francis K.L. Wong
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
Andrew Kean Seng Lim
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
,
James Hoipo Hui
1   Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
› Author Affiliations
Further Information

Publication History

15 December 2018

18 March 2019

Publication Date:
07 May 2019 (online)

Abstract

The tibial tubercle–trochlear groove (TT–TG) distance was originally described for computed tomography (CT) but has recently been used on magnetic resonance imaging (MRI) without sufficient evidence demonstrating its validity on MRI. The current review aims to evaluate (1) whether there is a difference in the TT–TG distances measured using CT and MRI, (2) whether both the TT–TG distances measured using CT and MRI could be used to differentiate between patients with or without patellofemoral instability, and (3) whether the same threshold of 15 to 20 mm can be applied for both TT–TG distances measured using CT and MRI. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that compared TT–TG distances either (1) between CT and MRI or (2) between patients with and without patellofemoral instability were included. A total of 23 publications were included in the review. These included a total of 3,040 patients. All publications reported the TT–TG distance to be greater in patients with patellofemoral instability as compared to those without patellofemoral instability. This difference was noted for both TT–TG distances measured on CT and on MRI. All publications also reported the TT–TG distance measured on CT to be greater than that measured on MRI (mean difference [MD] = 1.79 mm; 95% confidence interval [CI]: 0.91–2.68). Pooling of the studies revealed that the mean TT–TG distance for the control group was 12.85 mm (95% CI: 11.71–14.01) while the mean TT–TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04–19.62) when measured on CT. When measured on MRI, the mean TT–TG distance for the control group was 9.83 mm (95% CI: 9.11–10.54), while the mean TT–TG distance for patients with patellofemoral instability was 15.33 mm (95% CI: 14.24–16.42). Both the TTTG distances measured on CT and MRI could be used to differentiate between patients with and without patellofemoral instability. Patients with patellofemoral instability had significantly greater TT–TG distances than those without. However, the TT–TG distances measured on CT were significantly greater than that measured on MRI. Different cut-off values should, therefore, be used for TT–TG distances measured on CT and on MRI in the determination of normal versus abnormal values. Pooling of all the patients included in the review then suggest for 15.5 ± 1.5 mm to be used as the cut off for TT–TG distance measured on CT, and for 12.5 ± 2 mm to be used as the cut-off for TT–TG distance measured on MRI. The Level of evidence for this study is IV.

 
  • References

  • 1 Redziniak DE, Diduch DR, Mihalko WM. , et al. Patellar instability. J Bone Joint Surg Am 2009; 91 (09) 2264-2275
  • 2 Tan SHS, Ibrahim MM, Lee ZJ, Chee YKM, Hui JH. Patellar tracking should be taken into account when measuring radiographic parameters for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2018; 26 (12) 3593-3600
  • 3 Tan SHS, Tan LYH, Lim AKS, Hui JH. Hemiepiphysiodesis is a potentially effective surgical management for skeletally immature patients with patellofemoral instability associated with isolated genu valgum. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 845-849
  • 4 Tan SHS, Lim SY, Wong KL, Doshi C, Lim AKS, Hui JH. The outcomes of isolated distal realignment procedures in patellofemoral instability: a systematic review and meta-analysis. J Knee Surg 2019 Mar 1. doi: 10.1055/s-0039-1681052
  • 5 Tan SHS, Chng KSJ, Lim BY, Wong KL, Doshi C, Lim AKS, Hui JH. The difference between cartilaginous and bony Sulcus angles for patients with or without patellofemoral instability: a systematic review and meta-analysis. J Knee Surg 2019 Jan 24. doi: 10.1055/s-0038-1677541
  • 6 Tan SHS, Hui SJ, Doshi C, Wong KL, Lim AKS, Hui JH. The outcomes of distal femoral varus osteotomy in patellofemoral instability: a systematic review and meta-analysis. J Knee Surg 2019 Mar 1. doi: 10.1055/s-0039-1681043
  • 7 Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 2006; 13 (01) 26-31
  • 8 Ho CP, James EW, Surowiec RK. , et al. Systematic technique-dependent differences in CT versus MRI measurement of the tibial tubercle-trochlear groove distance. Am J Sports Med 2015; 43 (03) 675-682
  • 9 Camp CL, Stuart MJ, Krych AJ. , et al. CT and MRI measurements of tibial tubercle-trochlear groove distances are not equivalent in patients with patellar instability. Am J Sports Med 2013; 41 (08) 1835-1840
  • 10 Hinckel BB, Gobbi RG, Filho EN. , et al. Are the osseous and tendinous-cartilaginous tibial tuberosity-trochlear groove distances the same on CT and MRI?. Skeletal Radiol 2015; 44 (08) 1085-1093
  • 11 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007; 15 (02) 48-56
  • 12 Thakkar RS, Del Grande F, Wadhwa V. , et al. Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc 2016; 24 (09) 3021-3028
  • 13 Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG. , eds. Systematic Reviews in Health Care: Meta-Analysis in Context. London, U.K.: BMJ Publications; 2001: 285-321
  • 14 Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res 1993; 2 (02) 121-145
  • 15 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
  • 16 Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
  • 17 Whitehead A. Meta-Analysis of Controlled Clinical Trials. West Sussex: John Wiley & Sons, Ltd.; 2002
  • 18 Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017; 45 (01) 50-58
  • 19 Balcarek P, Jung K, Ammon J. , et al. 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 2010; 38 (11) 2320-2327
  • 20 Balcarek P, Ammon J, Frosch S. , et al. Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 2010; 26 (07) 926-935
  • 21 Balcarek P, Jung K, Frosch KH, Stürmer KM. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 2011; 39 (08) 1756-1761
  • 22 Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT. 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 2017; 45 (05) 1110-1116
  • 23 Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013; 41 (02) 374-384
  • 24 Daynes J, Hinckel BB, Farr J. Tibial Tuberosity-Posterior Cruciate Ligament Distance. J Knee Surg 2016; 29 (06) 471-477
  • 25 Düppe K, Gustavsson N, Edmonds EW. Developmental morphology in childhood patellar instability: age-dependent differences on magnetic resonance imaging. J Pediatr Orthop 2016; 36 (08) 870-876
  • 26 Ferlic PW, Runer A, Dirisamer F. , et al. The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation. Int Orthop 2018; 42 (05) 995-1000
  • 27 Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2388-2395
  • 28 Köhlitz T, Scheffler S, Jung T. , et al. Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 2013; 23 (04) 1067-1074
  • 29 Mohammadinejad P, Shekarchi B. Value of CT scan-assessed tibial tuberosity-trochlear groove distance in identification of patellar instability. Radiol Med (Torino) 2016; 121 (09) 729-734
  • 30 Pennock AT, Alam M, Bastrom T. Variation in tibial tubercle-trochlear groove measurement as a function of age, sex, size, and patellar instability. Am J Sports Med 2014; 42 (02) 389-393
  • 31 Skelley N, Friedman M, McGinnis M, Smith C, Hillen T, Matava M. Inter- and intraobserver reliability in the MRI measurement of the tibial tubercle-trochlear groove distance and trochlea dysplasia. Am J Sports Med 2015; 43 (04) 873-878
  • 32 Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 2015; 43 (04) 921-927
  • 33 Stepanovich M, Bomar JD, Pennock AT. Are the current classifications and radiographic measurements for trochlear dysplasia appropriate in the skeletally immature patient?. Orthop J Sports Med 2016; 4 (10) 2325967116669490
  • 34 Tensho K, Akaoka Y, Shimodaira H. , et al. What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population?. J Bone Joint Surg Am 2015; 97 (17) 1441-1448
  • 35 Tse MS, Lie CW, Pan NY, Chan CH, Chow HL, Chan WL. Tibial tuberosity-trochlear groove distance in Chinese patients with or without recurrent patellar dislocation. J Orthop Surg (Hong Kong) 2015; 23 (02) 180-181