TY - JOUR
T1 - Current evidence advocates use of a new pathologic tibial tubercle–posterior cruciate ligament distance threshold in patients with patellar instability
AU - Boutris, Nickolas
AU - Delgado, Domenica A.
AU - Labis, John S.
AU - McCulloch, Patrick C.
AU - Lintner, David M.
AU - Harris, Joshua D.
N1 - Funding Information:
Authors NB, DAD, JSL, and DML declare no conflict of interest. Author PCM is on the Speaker?s Bureau for company/supplier (Vericel), receives research support from company/supplier (DePuy, A Johnson & Johnson Company; Arthrex; Zimmer), is on the editorial board for Journal of Knee Surgery, Orthobullets.com. Author JDH is on the Editorial board for Arthroscopy: The Journal of Arthroscopic and Related Surgery, Frontiers In Surgery; receives publication royalties from SLACK, Inc; receives research support from Depuy Synthes, Smith & Nephew; is a paid consultant for NIA Magellan, Smith & Nephew; is on committees for AANA Research, AOSSM Self-Assessment, AAOS Osteoarthritis Pain and Function Workgroup. No funding was received for this study.
Publisher Copyright:
© 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Purpose: To determine (1) whether a correlation exists between tibial tubercle–posterior cruciate ligament (TT-PCL) and tibial tubercle–trochlear groove (TT-TG) distances in patellar instability patients; (2) reliability when measuring TT-PCL distance; (3) whether TT-PCL distances measured on MRI are equivalent to those on CT; and (4) whether a correlation exists between TT-PCL distance and number of instability events or recurrence of instability following stabilization surgery. Methods: A systematic review was performed using PRISMA guidelines. Clinical studies investigating the relationships of TT-PCL with TT-TG on CT and/or MRI in patellar instability patients were sought. English language studies with Levels of evidence I–IV were eligible for inclusion. Results: Four studies (285 subjects [300 knees] with patellar instability [74.2% female; mean age 26.1 ± 8.2 years]; 114 controls [144 knees; 77% female; mean age 23.1 years]) were included. Mean TT-PCL of instability and control groups was 21.1 ± 4.1 and 18.8 ± 4.0 mm (p < 0.0001), respectively. Two studies reported significant positive (strong and moderate) correlations between TT-PCL and TT-TG MRI measurements in instability patients. All four investigations reported excellent interobserver and intraobserver reliability in MRI measurement of TT-PCL distance. No study compared TT-PCL distances on MRI and CT. No study assessed correlation between TT-PCL distance and number of instability events or recurrence of instability after surgery. Conclusion: A moderate-to-strong positive correlation exists between TT-PCL and TT-TG measurements taken from MRIs of patellar instability patients. There is excellent interobserver and intraobserver reliability when taking TT-PCL measurements using MRI. This review advocates use of a new pathologic TT-PCL threshold of 21 mm. Level of evidence: Level III, systematic review of Level II–III studies.
AB - Purpose: To determine (1) whether a correlation exists between tibial tubercle–posterior cruciate ligament (TT-PCL) and tibial tubercle–trochlear groove (TT-TG) distances in patellar instability patients; (2) reliability when measuring TT-PCL distance; (3) whether TT-PCL distances measured on MRI are equivalent to those on CT; and (4) whether a correlation exists between TT-PCL distance and number of instability events or recurrence of instability following stabilization surgery. Methods: A systematic review was performed using PRISMA guidelines. Clinical studies investigating the relationships of TT-PCL with TT-TG on CT and/or MRI in patellar instability patients were sought. English language studies with Levels of evidence I–IV were eligible for inclusion. Results: Four studies (285 subjects [300 knees] with patellar instability [74.2% female; mean age 26.1 ± 8.2 years]; 114 controls [144 knees; 77% female; mean age 23.1 years]) were included. Mean TT-PCL of instability and control groups was 21.1 ± 4.1 and 18.8 ± 4.0 mm (p < 0.0001), respectively. Two studies reported significant positive (strong and moderate) correlations between TT-PCL and TT-TG MRI measurements in instability patients. All four investigations reported excellent interobserver and intraobserver reliability in MRI measurement of TT-PCL distance. No study compared TT-PCL distances on MRI and CT. No study assessed correlation between TT-PCL distance and number of instability events or recurrence of instability after surgery. Conclusion: A moderate-to-strong positive correlation exists between TT-PCL and TT-TG measurements taken from MRIs of patellar instability patients. There is excellent interobserver and intraobserver reliability when taking TT-PCL measurements using MRI. This review advocates use of a new pathologic TT-PCL threshold of 21 mm. Level of evidence: Level III, systematic review of Level II–III studies.
KW - Patellar dislocation
KW - Patellar instability
KW - TT-PCL
KW - TT-TG
KW - Tibial tubercle–posterior cruciate ligament
KW - Tibial tubercle–trochlear groove
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U2 - 10.1007/s00167-017-4716-2
DO - 10.1007/s00167-017-4716-2
M3 - Review article
C2 - 28918500
AN - SCOPUS:85029542379
SN - 0942-2056
VL - 26
SP - 2733
EP - 2742
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
IS - 9
ER -