Tibial Tubercle–Roman Arch Distance: A New Measurement of Patellar Dislocation and Indication of Tibial Tubercle Osteotomy

Abstract

Background: The surgical indication for tibial tubercle osteotomy (TTO) has been based on a tibial tubercle–trochlear groove (TT-TG) distance of 20 mm or greater in patients with patellar dislocation. However, the measurement of this parameter is less reliable in patients with trochlear dysplasia. Hypothesis: The novel measurement of tibial tubercle–Roman arch (TT-RA) distance would be a reliable parameter for identifying the relative position of the tibial tubercle in patients with patellar dislocation, especially those with trochlear dysplasia. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 56 patients with a diagnosis of patellar dislocation and 60 volunteers (60 knee joints) without a history of lower extremity pain or injury were included in our study. The TT-RA distance, TT-TG distance, and some femoral anatomic parameters were assessed by use of computed tomography. The measurements were performed by a radiologist and an orthopaedic surgeon in a blinded and randomized fashion. The difference in each parameter between the study and control groups was analyzed through use of an unpaired t test. Receiver operating characteristic curve analysis was performed to evaluate the discriminatory capacity of the included parameters. The cutoff values of the included measurements with specificity and sensitivity were calculated. In addition, the TT-TG distance and TT-RA distance were analyzed using the Dejour classification to evaluate the intraclass correlation coefficient (ICC) of each parameter in different types of femoral trochlea. Result: A significant difference for TT-RA distance was found between the study group (23.24 ± 4.41 mm) and control group (19.15 ± 4.24 mm) ( P < .001). The TT-RA distance had an area under the curve of 0.757. At a value greater than 23.74 mm, TT-RA distance had 53.57% sensitivity and 88.33% specificity for patellar dislocation. The ICCs of TT-RA distance measurements were excellent in all Dejour classifications (>0.939), whereas the ICCs of TT-TG distance measurements were relatively lower than the ICCs of TT-RA distance measurements. According to the data from included healthy individuals, the pathological TT-RA distance threshold was 26 mm. Conclusion: Compared with TT-TG distance, the TT-RA distance is a more reliable parameter for identifying the relative position of the tibial tubercle in patients with trochlear dysplasia. For patients with a TT-RA distance greater than 26 mm, surgery should be considered to correct the malposition of the tibial tubercle.