Oregon Health and Science University, Sam Jackson Hall, Portland, Oregon, U.S.A.
Vanderbilt University Medical Center, South Tower, Nashville, Tennessee, U.S.A.
Arthroscopy. 2017 Nov;33(11):2026-2034. doi: 10.1016/j.arthro.2017.06.020. Epub 2017 Aug 26.
To determine best practices for consistent and accurate evaluation of coronal alignment in patients with patellofemoral (PF) instability.
Six reviewers examined 239 knee magnetic resonance images (MRIs) in patients with PF instability and anterior cruciate ligament (ACL) rupture. Measurements included tibial tubercle-to-trochlear groove (TT-TG) distance measured at the most proximal and distal portions of the trochlea, tibial tubercle-to-PCL (TT-PCL) distance, and Dejour classification of trochlear dysplasia.
Interrater reliability was low for Dejour classification (k = 0.289), but improved to moderate (k = 0.448) when patients were separated into normal/Dejour A and Dejour B/C/D. Interrater reliability was high for proximal and distal TT-TG measurements (interclass correlation coefficients [ICCs] = 0.807 and 0.936, respectively). TT-PCL was moderately reliable (ICC = 0.625), and correlated with TT-TG (r = 0.457, P < .001 proximal and r = 0.451, P < .001 distal). No significant difference was found between the proximal and distal measurements of TT-TG in each patient, though the PF group exhibited higher values than the ACL group (P < .001 for both). TT-PCL was significantly higher for the PF group than the ACL group (P = .015), but this difference lost significance when the group was divided by the TT-PCL cutoff of 24 mm (P = .371).
The proximal and distal techniques for measuring the TT-TG distance are similar to each other, and reliable despite level of reviewer training or presence of dysplasia. The TT-TG distance was predictive of patellofemoral instability. The TT-PCL distance was found to be less reliable than either method of measuring the TT-TG distance. Thus, this study demonstrated TT-TG to be superior to TT-PCL as a measurement of coronal malalignment. Given the variability in Dejour classification in this and other studies, a more reliable classification system for trochlear dysplasia as defined on cross-sectional imaging is warranted.
Level III, retrospective clinical trial.
确定在髌股（PF）不稳定患者中对冠状面对线进行一致且准确评估的最佳实践。
6 名评估员检查了 239 例 PF 不稳定伴前交叉韧带（ACL）断裂患者的膝关节磁共振成像（MRI）。测量包括滑车最近端和最远端的胫骨结节至滑车沟（TT-TG）距离、胫骨结节至后交叉韧带（TT-PCL）距离和滑车发育不良的 Dejour 分类。
Dejour 分类的组内信度较低（k=0.289），但当患者分为正常/Dejour A 和 Dejour B/C/D 时，信度提高到中度（k=0.448）。TT-TG 的近端和远端测量值具有高度的组内信度（组间相关系数[ICC]分别为 0.807 和 0.936）。TT-PCL 具有中度可靠性（ICC=0.625），与 TT-TG 相关（r=0.457，P<0.001 近端和 r=0.451，P<0.001 远端）。尽管 PF 组的 TT-TG 近端和远端测量值均高于 ACL 组（两者均 P<0.001），但在每位患者中，近端和远端 TT-TG 测量值之间无显著差异。TT-PCL 在前交叉韧带组中明显高于前交叉韧带组（P=0.015），但当按 TT-PCL 截断值 24mm 分组时，差异无统计学意义（P=0.371）。
TT-TG 距离的近端和远端测量技术彼此相似，尽管评估员的培训水平或发育不良的存在，其可靠性仍然很高。TT-TG 距离可预测髌股不稳定。与 TT-TG 距离的任何一种测量方法相比，TT-PCL 距离的可靠性都较低。因此，本研究表明 TT-TG 作为冠状面对线不良的测量方法优于 TT-PCL。鉴于在本研究和其他研究中 Dejour 分类存在差异，需要一种更可靠的用于横断面成像的滑车发育不良分类系统。
III 级，回顾性临床试验。
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