Axial scan orientation and the tibial tubercle-trochlear groove distance: error analysis and correction

The tibial tubercle (TT)-trochlear groove (TG) distance is an important metric in the assessment of patellofemoral dysfunction and is routinely measured on axial MRI and CT. This study examines error in measurements of the TT-TG distance related to variance in axial MRI scan orientation.

Isotropic 3D turbo spin-echo MRI of the extended knee was performed in 12 healthy subjects. The z-axis of the scanner defines the perpendicular to a routine axial plane, and the anatomic axial plane is parallel to the knee joint. Isotropic MRI was reformatted into routine and anatomic axial planes and in axial planes simulating 5° of femoral adduction and abduction relative to the anatomic plane. A method for correcting the TT-TG distance to account for variable axial scan orientation is presented.

Five degrees of simulated femoral abduction is associated with a mean increase in the TT-TG distance of 38% (SD = 17%), whereas 5° of simulated femoral adduction is associated with a mean decrease in the TT-TG distance of 51% (SD = 39%). The average deviation of the routine axial plane from the anatomic axial plane was 5.0° abduction (SD = 2.3°). The simplest correction method reduced the mean discrepancy in the observed TT-TG distance by 68% and 72% in simulated femoral abduction and adduction, respectively.

The TT-TG distance is sensitive to small changes in femoral alignment and should be interpreted with caution if axial image acquisition is not standardized. Knowing the vertical separation of the TT from the TG facilitates a simplified correction of the TT-TG distance, which is as effective as more complex corrections.