University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA.
Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):697-704. doi: 10.1007/s00167-017-4527-5. Epub 2017 Apr 4.
An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements.
Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient.
The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient.
The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy.
Diagnostic study, Level III.
外侧股四头肌向量的增加与外侧髌骨脱位有关。当股四头肌向量“过大”时，通常建议通过胫骨结节内移来纠正这种增加的向量。这可以通过 Q 角和/或滑车沟角（TSA）的体格检查测量以及胫骨结节-滑车沟（TT-TG）距离的磁共振成像（MRI）测量来评估。本研究检查了外侧股四头肌向量（TT-TG、Q 角、TSA）的三种客观测量值之间的关系。次要目标是将髌骨外侧倾斜与这些测量值相关联。
纳入 2010 年 9 月至 2011 年 6 月期间接受髌股稳定手术的连续患者。术中体格检查测量 Q 角和 TSA。MRI 测量 TT-TG 和髌骨倾斜。使用 Pearson 相关系数比较 TT-TG 与 TSA、Q 角和髌骨倾斜。
研究队列包括 49 名年龄在 12-37 岁（平均 23.2 岁）的患者，其中 62%为女性。Pearson 相关系数显示 TT-TG 与 TSA 和 Q 角均呈正相关（p<0.01）。倾斜和 TT-TG 呈正相关，但无统计学意义。尽管每个测量值与 TT-TG 均呈正相关，但患者之间的相关性并不一致。换句话说，如果 TT-TG 升高，则不能保证所有其他测量值，包括倾斜，在该患者中也升高。
在接受髌股不稳定手术的患者中，TT-TG 距离与 TSA 和 Q 角的测量值具有显著正相关性。临床意义是，个体患者内的变异性表明在手术干预之前和期间需要考虑 TSA 和 TT-TG，以避免胫骨结节内移术的过度矫正。
诊断研究，III 级。
