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Related Experiment Videos

Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation.

Frank-Christiaan B M Wagenaar1, Sander Koëter, Patricia G Anderson

  • 1Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands. f.b.m.wagenaar@gmail.com

The Knee
|December 5, 2006
PubMed
Summary

Measuring the tubercle-trochlear groove (TT-TG) distance using axial radiographs is unreliable for diagnosing patellar instability. Computed tomography (CT) remains the superior imaging modality for accurate TT-TG assessment.

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Area of Science:

  • Orthopedics
  • Radiology
  • Biomechanics

Background:

  • Patellar instability is often linked to an increased lateral distance between the tibial tubercle and trochlear groove (TT-TG).
  • Accurate measurement of the TT-TG distance is crucial for diagnosing and managing patellar instability.

Purpose of the Study:

  • To compare the accuracy of TT-TG measurements on reformatted computed tomography (CT) versus 30-degree axial conventional radiography (CR).
  • To evaluate the feasibility of using lead markers for TT-TG assessment on CR.

Main Methods:

  • Seven symptomatic knees were analyzed using both CT and 30-degree axial CR with lead markers.
  • Intra- and interobserver reliability were assessed using the intraclass correlation coefficient (ICC).

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Main Results:

  • Lead markers successfully visualized the tibial tubercle on axial CR.
  • Significant measurement error (18 mm) was observed for TT-TG on axial CR compared to CT (4 mm).
  • Despite good reliability (ICC >0.86), the large measurement error led to early study termination.

Conclusions:

  • Axial conventional radiography, even with lead markers, is not a reliable substitute for CT in measuring TT-TG distance.
  • Patient and marker positioning are critical factors influencing measurement accuracy on CR.
  • CT remains the gold standard for accurately detecting pathological TT-TG distances in patellar instability.