Symptomatic patellofemoral cartilage lesions showed greater vertical TT-TG distance

Drew Lansdown

ORLANDO — Patients with symptomatic patellofemoral cartilage lesions had a significantly greater vertical tibial tubercle-trochlear groove distance with a more posterior tibial tubercle compared to patients with normal or asymptomatic patellofemoral cartilage, according to results presented at the Arthroscopy Association of North America Annual Meeting.

Perspective from John P. Fulkerson, MD

Drew Lansdown, MD, and colleagues categorized patients into three groups based on whether they underwent surgical treatment for patellofemoral cartilage lesions (group 1), partial meniscectomy with normal patellofemoral cartilage (group 2) or partial meniscectomy for asymptomatic patellar chondrosis with abnormal patellar cartilage (group 3). Researchers measured vertical tibial tubercle-trochlear groove (TT-TG) distance, sulcus angle, standard TT-TG, Canton-DeChamps index and knee flexion angle.

Lansdown noted patients with patellofemoral cartilage lesions were significantly younger compared with patients in the meniscectomy groups.

“We found in group 1, the patients undergoing patellofemoral cartilage treatment, had a significantly higher vertical TT-TG measurement, measuring 5.9 mm relative to 0.8 mm in group 2,” Lansdown said in his presentation here.

The difference between group 1 and group 2 was statistically significant, according to Lansdown. He added patients with patellofemoral chondrosis were found to be in between groups 1 and 2.

“We had excellent intra- and interobserver reproducibility and this is in line with a standard TT-TG measurement, ranging from 0.90 to 0.98,” Lansdown said. – by Casey Tingle

Reference:

Lansdown D, et al. The vertical tibial tubercle-trochlear groove distance as a measurement of sagittal imbalance in patients with symptomatic patellofemoral chondral lesions. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.

Disclosure: Lansdown reports he receives other financial or material support from Arthrex Inc. and Smith & Nephew and is a board or committee member for the Arthroscopy Association of North America.

Perspective

John P. Fulkerson, MD

This is a very interesting presentation. I am not too surprised by the findings, particularly since anteriorization of the tibial tuberosity relieves pressure in the patellofemoral joint, particularly unloading the distal patella. Anteriorization of the tibial tuberosity also helps relieve pain in patients with patellofemoral arthritis and is useful in patellofemoral cartilage surgery. I believe this is a measure we need to continue studying and learn more about how it can best be used in clinical practice, particularly as an index for determining when to perform anteriorization of the tibial tuberosity.

John P. Fulkerson, MD

President of The Patellofemoral Foundation

Hartford, Connecticut

Disclosures: