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Tibial tuberosity-trochlear groove distance: does it measure up?

Harry Krishnan¹, Jonathan D Eldridge², Damian Clark²

¹Frimley Health Foundation Trust, Frimley, Surrey, UK.

Bone & Joint Open

|March 24, 2022

Summary

The tibial tuberosity-trochlear groove (TT-TG) measurement is commonly used for patellar instability but has limitations. This review questions if TT-TG sufficiently captures the underlying anatomy for surgical planning in patellar instability.

Keywords:

Patellar instability TT-TG Tibial tuberosity dysplastic trochlear knee osteotomy patella patella alta pathoanatomy stability strengths tibial tubercle osteotomy tibial tuberosity-trochlear groove (TT-TG) distances trochlea trochlear groove

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Area of Science:

Orthopedics
Biomechanics
Radiology

Background:

Patellar instability is often linked to anatomical variations like patella alta and trochlear dysplasia.
Lateralization of the extensor mechanism is implicated, but its contribution and measurement are debated.
The tibial tuberosity-trochlear groove (TT-TG) distance is a frequent imaging metric for assessing this lateralization.

Purpose of the Study:

To evaluate if the TT-TG distance adequately represents the pathoanatomy of patellar instability.
To determine if TT-TG measurements aid in surgical planning for patellar instability.

Main Methods:

Systematic review of literature concerning TT-TG measurements and patellar instability.
Analysis of factors influencing TT-TG measurements.
Evaluation of surgical outcomes following procedures addressing TT-TG.

Main Results:

The TT-TG distance is influenced by numerous factors, necessitating careful interpretation.
Medializing tibial tubercle osteotomy may not fully correct the root anatomical issues contributing to instability.
The sufficiency of TT-TG in summarizing complex pathoanatomy remains questionable.

Conclusions:

The TT-TG distance alone may not fully capture the pathoanatomy of patellar instability.
Relying solely on TT-TG for surgical planning may not address underlying anatomical problems.
Further investigation into comprehensive assessment of patellar instability pathoanatomy is warranted.