BLOG: Plan patellar instability correction with 3D engineering
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Planning patella instability correction has improved greatly thanks to the Lyon “menu á la carte” and the Dejour classification of trochlea dysplasia.
The advent of 3D imaging, however, has added a powerful new perspective, particularly with regard to understanding the complexities of trochlea dysplasia. While understanding trochlear curvature and deformity optimally helps improve decision-making in patella instability surgery, laterality of the patella tracking vector, as affected by the tibial tubercle-trochlear groove (TT-TG) relationship, or TT-TG measurement, is an important indicator for when to move the tibial tubercle.
Johannes Sieberer, an engineer at Yale, has recently refined our understanding of the TT – TG measurement in planning patellofemoral instability surgery. His work, which will be presented at the Orthopedic Research Society from Feb. 2-4 in Long Beach, California, refines this measurement, making it more accurate and informative. Sieberer splits TT-TG into three components: medial-lateral orientation of the femoral trochlea, medial-lateral position of the tibial tubercle and tibiofemoral rotation resulting in consistently precise TT-TG determination. Another outcome of Sieberer's work is a finding that knee position at time of MRI varies substantially, introducing another, and surprising amount of variability to TT-TG measurement, as previously noted by Miho J. Tanaka, MD, and others.
Using 3D engineering reduces the risk of error when using TT-TG for surgical planning by defining it precisely. Most importantly, for those who do not have 3D capability, assure consistent knee position at the time of MRI and be aware of the variabilities of TT-TG measurement, which impact surgical decision-making. Surgical decisions should be based on multiple factors, and 3D helps greatly in optimizing accuracy.
Reference:
Yu KE, et al. Arthrosc Tech. 2023;doi:10.1016/j.eats.2023.02.004.
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