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- Title
Current evidence advocates use of a new pathologic tibial tubercle-posterior cruciate ligament distance threshold in patients with patellar instability.
- Authors
Boutris, Nickolas; Delgado, Domenica A.; Labis, John S.; McCulloch, Patrick C.; Lintner, David M.; Harris, Joshua D.
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.<bold>Level Of Evidence: </bold>Level III, systematic review of Level II-III studies.
- Subjects
POSTERIOR cruciate ligament; JOINT hypermobility; TIBIALIS posterior; PATELLA; PATELLA dislocation; KNEE; JOINT dislocations; MAGNETIC resonance imaging; RESEARCH evaluation; TIBIA; SYSTEMATIC reviews; DISEASE relapse; RESEARCH bias
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2018, Vol 26, Issue 9, p2733
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-017-4716-2