Xu Chenyue, Cui Zhaoxia, Yan Lirong, Chen Zheng, Wang Fei
Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China.
Hebei Medical University, Shijiazhuang, Hebei, China.
Orthop J Sports Med. 2022 Aug 16;10(8):23259671221113841. doi: 10.1177/23259671221113841. eCollection 2022 Aug.
Increased tibial tuberosity-trochlear groove (TT-TG) distance is an important indicator of medial tibial tubercle transfer in the surgical management of lateral patellar dislocation (LPD). Changes to TT-TG distance are determined by a combination of several anatomical factors.
To (1) determine the anatomical components related to increased TT-TG distance and (2) quantify the contribution of each to identify the most prominent component.
Case-control study; Level of evidence, 3.
Included were 80 patients with recurrent LPD and 80 age- and body mass index-matched controls. The 2 groups were compared in TT-TG distance and its related anatomical components: tibial tubercle lateralization (TTL), trochlear groove medialization, femoral anteversion, tibiofemoral rotation (TFR), tibial torsion, and mechanical axis deviation (MAD). The Pearson correlation coefficient () was calculated to evaluate the association between increased TT-TG distance and its anatomical parameters, and factors that met the inclusion criteria of < .05 and ≥ 0.30 were analyzed via stepwise multivariable linear regression analysis to predict TT-TG distance.
The LPD and control groups differed significantly in TT-TG distance, TTL, TFR, and MAD ( < .001 for all). Increased TT-TG distance was significantly positively correlated with TTL ( = 0.376; < .001), femoral anteversion ( = 0.166; = .036), TFR ( = 0.574; < .001), and MAD ( = 0.415; < .001), and it was signficantly negatively correlated with trochlear groove medialization ( = -0.178; = .024). The stepwise multivariable analysis revealed that higher TTL, excessive knee external rotation, and excessive knee valgus were statistically significant predictors of greater TT-TG distance ( < .001 for all). The standardized estimates that were used for evaluating the predictive values were larger for TFR compared with those for TTL and MAD.
TTL, TFR, and MAD were the main independent anatomical components associated with increased TT-TG distance, with the most prominent component being TFR. The association of TT-TG distance to each component analyzed in our study may help guide surgical planning.
在外侧髌骨脱位（LPD）的手术治疗中，胫骨结节 - 滑车沟（TT - TG）距离增加是内侧胫骨结节转移的重要指标。TT - TG距离的变化由多种解剖因素共同决定。
（1）确定与TT - TG距离增加相关的解剖学组成部分；（2）量化各组成部分的贡献以识别最主要的组成部分。
病例对照研究；证据等级，3级。
纳入80例复发性LPD患者和80例年龄及体重指数匹配的对照者。比较两组的TT - TG距离及其相关解剖学组成部分：胫骨结节外移（TTL）、滑车沟内移、股骨前倾、胫股旋转（TFR）、胫骨扭转和机械轴偏移（MAD）。计算Pearson相关系数（）以评估TT - TG距离增加与其解剖学参数之间的关联，对满足<0.05且≥0.30纳入标准的因素进行逐步多变量线性回归分析以预测TT - TG距离。
LPD组和对照组在TT - TG距离、TTL、TFR和MAD方面存在显著差异（所有均<0.001）。TT - TG距离增加与TTL（=0.376；<0.001）、股骨前倾（=0.166；=0.036）、TFR（=0.574；<0.001）和MAD（=0.415；<0.001）显著正相关，与滑车沟内移（=-0.178；=0.024）显著负相关。逐步多变量分析显示，较高的TTL、过度的膝关节外旋和过度的膝关节外翻是TT - TG距离增加的统计学显著预测因素（所有均<0.001）。与TTL和MAD相比，用于评估预测值的标准化估计值在TFR方面更大。
TTL、TFR和MAD是与TT - TG距离增加相关的主要独立解剖学组成部分，最主要的组成部分是TFR。本研究中分析的TT - TG距离与各组成部分的关联可能有助于指导手术规划。
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