The Tibial Tuberosity–Rotational Angle as a Novel Predisposing Parameter for Patellar Dislocation

Abstract

Background: The tibial tuberosity (TT) in the axial plane is located on a curved line along the anterior cortex of the proximal tibia. Therefore, the linear measurement of TT position may not fully reflect TT malposition. Purpose: To introduce TT–rotational angle (TT-RA) as a new anatomical parameter, which means the rotation of the TT relative to the dorsal condylar line of the tibia, and to validate its predictive value for patellar dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 46 patients with a history of patellar dislocation and 46 age- and sex-matched controls who underwent axial magnetic resonance imaging. Seven radiological parameters were measured and compared between the 2 groups, including TT–trochlear groove (TT-TG) distance, tibial tubercle–posterior cruciate ligament (TT-PCL) distance, TT-PCL ratio, TT lateralization (TTL), trochlear groove medialization (TGM), TT-RA, trochlear groove–posterior condylar axis angle (TG-PCA), and knee rotation. The predictive values of parameters for patellar dislocation were assessed using multiple logistic regression analysis. Results: The intra- and interobserver correlation coefficients for measuring the radiographic parameters showed good to excellent values., respectively. There were significant differences in the TT-TG distance (13.9 vs 6.8 mm; P < .001), TT-RA (16.0° vs 9.1°; P < .001), TG-PCA (93.7° vs 95.4°; P = .017), and knee rotation (0.9° vs 5.3°; P < .001) between the 2 groups. However, there was no significant difference in TT-PCL distance (20.7 vs 19.4 mm; P = .075), TT-PCL ratio (28.0% vs 26.6%; P = .136), TTL (65.7% vs 64.9%; P = .270), or TGM (54.9% vs 55.0%; P = .923). Multivariable analysis showed that 3 parameters were significantly associated with patellar dislocation: TT-RA (OR, 1.57; P < .001), TT-TG distance (OR, 1.52; P = .002), and knee rotation (OR, 0.75; P = .022). Conclusion: The TT-RA was a reliable predisposing parameter of patellar instability. It can be an alternative method of measurement when the TT-TG distance is not clearly defined.