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Metin Polat1, Reha Nevzat Tandogan1, Evsen Polattas Solak2

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Tibial-based measurements reveal external rotation of the tibial tuberosity in patients with patellar instability. These novel methods offer reproducible assessments for diagnosing this condition.

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Area of Science:

  • Orthopedic surgery
  • Biomechanical analysis
  • Medical imaging

Background:

  • Current methods for measuring tibial tuberosity external rotation rely on femoral landmarks.
  • This reliance on femoral landmarks can limit reproducibility and diagnostic accuracy.

Purpose of the Study:

  • To develop and validate novel, reproducible tibial-based methods for measuring tibial tuberosity external rotation.
  • To assess the utility of these tibial-based methods in patients with patellar instability.

Main Methods:

  • Magnetic resonance imaging (MRI) data from 61 patellar instability patients and 61 controls were analyzed.
  • Three new tibial-based angles (PA-TA, GC-TA, PA-MT) and a femoral-based angle (sTEA-TA) were measured.
  • Tibial tuberosity-trochlear groove (TT-TG) distance was also calculated and compared between groups.

Main Results:

  • Patients with patellar instability exhibited significantly greater tibial tuberosity external rotation across multiple measurements (PA-TA, GC-TA, sTEA-TA) compared to controls.
  • The mean TT-TG distance was also significantly higher in the instability group.
  • Receiver operating characteristic (ROC) curve analysis identified cutoff values for predicting instability, with TT-TG distance showing the highest predictive value (AUC = 0.863).

Conclusions:

  • External rotation of the tibial tuberosity is a significant finding in patients with patellar instability.
  • The developed tibial-based measurements (PA-TA, GC-TA) provide reproducible assessments of this malalignment.
  • These findings suggest that tibial-based measurements can effectively demonstrate intrinsic proximal tibial malalignment in patellar instability.