Normative Values of Tibial Tubercle-Trochlear Groove Distance and Tibial Tubercle-Posterior Cruciate Ligament Distance in Children
BACKGROUND: Patellar instability is a common knee pathology in skeletally immature patients. In skeletally mature populations, a tibial tubercle-trochlear groove (TT-TG) distance of ≥20 mm is generally considered a pathological value. However, as pediatric patients grow and as the TT-TG distance varies with age, applying the same cutoff value as adult patients to them is unreasonable.
PURPOSE/HYPOTHESIS: This study aimed to analyze the normative values of the TT-TG and tibial tubercle-posterior cruciate ligament (TT-PCL) distances in children with no patellofemoral instability and to propose the cutoff value of the TT-TG and TT-PCL distances predictive of increased risk of patellofemoral instability in pediatric patients. We hypothesized that the TT-TG and TT-PCL distances increase with age in children and adolescents.
STUDY DESIGN: Cross-sectional study; Level of evidence, 3.
METHODS: Magnetic resonance imaging scans of the knee were collected from the patellar instability group and the control group. The TT-TG and TT-PCL distances were measured. The normalized values of the TT-TG and TT-PCL distances were calculated by dividing them by the femoral width. Segmented analysis with 1 breakpoint was performed for both the TT-TG and the TT-PCL distances. The optimal cutoff values of the TT-TG and TT-PCL distances were calculated by maximizing the sum of the sensitivity and specificity.
RESULTS: A total of 87 patients had patellar instability, and 509 patients did not. The median values of TT-TG and TT-PCL distances in the control group (8.18 mm and 19.48 mm, respectively) were significantly smaller than those in the instability group (16.10 mm and 24.41 mm, respectively). For those aged <15 years, the TT-TG distance significantly increased by 0.39 mm as the age increased by 1 year. The TT-PCL distance increased by 1.14 mm/year until the age of 11 years. In our cohort, the cutoff value of the TT-TG distance of 14.90 mm yielded 66% sensitivity and 81.9% specificity for predicting an increased risk of patellar instability. The cutoff value of the TT-PCL distance of 23.68 mm yielded 63.9% sensitivity and 65.3% specificity for predicting an increased risk of patellar instability.
CONCLUSION: In our cohort of 596 participants, we have documented the normative values of the TT-TG and TT-PCL distances in children aged <20 years. During the surgery for patellar instability in pediatric patients, orthopaedic surgeons should consider the normative values of the TT-TG and TT-PCL distances according to age to determine which patients need distal realignment surgery.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
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| Enthalten in: |
The American journal of sports medicine - 51(2023), 7 vom: 24. Juni, Seite 1785-1791 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Park, Se Jin [VerfasserIn] |
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| Links: |
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| Themen: |
Children |
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| Anmerkungen: |
Date Completed 02.06.2023 Date Revised 08.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/03635465231165521 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355964422 |
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| 100 | 1 | |a Park, Se Jin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Normative Values of Tibial Tubercle-Trochlear Groove Distance and Tibial Tubercle-Posterior Cruciate Ligament Distance in Children |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 08.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Patellar instability is a common knee pathology in skeletally immature patients. In skeletally mature populations, a tibial tubercle-trochlear groove (TT-TG) distance of ≥20 mm is generally considered a pathological value. However, as pediatric patients grow and as the TT-TG distance varies with age, applying the same cutoff value as adult patients to them is unreasonable | ||
| 520 | |a PURPOSE/HYPOTHESIS: This study aimed to analyze the normative values of the TT-TG and tibial tubercle-posterior cruciate ligament (TT-PCL) distances in children with no patellofemoral instability and to propose the cutoff value of the TT-TG and TT-PCL distances predictive of increased risk of patellofemoral instability in pediatric patients. We hypothesized that the TT-TG and TT-PCL distances increase with age in children and adolescents | ||
| 520 | |a STUDY DESIGN: Cross-sectional study; Level of evidence, 3 | ||
| 520 | |a METHODS: Magnetic resonance imaging scans of the knee were collected from the patellar instability group and the control group. The TT-TG and TT-PCL distances were measured. The normalized values of the TT-TG and TT-PCL distances were calculated by dividing them by the femoral width. Segmented analysis with 1 breakpoint was performed for both the TT-TG and the TT-PCL distances. The optimal cutoff values of the TT-TG and TT-PCL distances were calculated by maximizing the sum of the sensitivity and specificity | ||
| 520 | |a RESULTS: A total of 87 patients had patellar instability, and 509 patients did not. The median values of TT-TG and TT-PCL distances in the control group (8.18 mm and 19.48 mm, respectively) were significantly smaller than those in the instability group (16.10 mm and 24.41 mm, respectively). For those aged <15 years, the TT-TG distance significantly increased by 0.39 mm as the age increased by 1 year. The TT-PCL distance increased by 1.14 mm/year until the age of 11 years. In our cohort, the cutoff value of the TT-TG distance of 14.90 mm yielded 66% sensitivity and 81.9% specificity for predicting an increased risk of patellar instability. The cutoff value of the TT-PCL distance of 23.68 mm yielded 63.9% sensitivity and 65.3% specificity for predicting an increased risk of patellar instability | ||
| 520 | |a CONCLUSION: In our cohort of 596 participants, we have documented the normative values of the TT-TG and TT-PCL distances in children aged <20 years. During the surgery for patellar instability in pediatric patients, orthopaedic surgeons should consider the normative values of the TT-TG and TT-PCL distances according to age to determine which patients need distal realignment surgery | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a children | |
| 650 | 4 | |a patellar instability | |
| 650 | 4 | |a tibial tuberosity–posterior cruciate ligament distance | |
| 650 | 4 | |a tibial tuberosity–trochlear groove distance | |
| 700 | 1 | |a Won, Seung Hyun |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Moon Seok |e verfasserin |4 aut | |
| 700 | 1 | |a Sung, Ki Hyuk |e verfasserin |4 aut | |
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