Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3243-3258. doi: 10.1007/s00167-023-07358-3. Epub 2023 Mar 6.
To determine the reliability and diagnostic accuracy of tibial tubercle-trochlear groove (TT-TG) distance versus tibial tubercle-posterior cruciate ligament (TT-PCL) distance, and to determine cutoff values of these measurements for pathological diagnosis in the context of patellar instability.
Three databases MEDLINE, PubMed and EMBASE were searched from inception to October 5, 2022 for literature outlining comparisons between TT-TG and TT-PCL in patellar instability patients. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on inter-rater and intra-rater reliability, receiver-operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, as well as odds ratios, cutoff values for pathological diagnosis and correlations between TT-TG and TT-PCL were recorded. The MINORS score was used for all studies in order to perform a quality assessment of included studies.
A total of 23 studies comprising 2839 patients (2922 knees) were included in this review. Inter-rater reliability ranged from 0.71 to 0.98 and 0.55 to 0.99 for TT-TG and TT-PCL, respectively. Intra-rater reliability ranged from 0.74 to 0.99 and 0.88 to 0.98 for TT-TG and TT-PCL, respectively. AUC measuring diagnostic accuracy of patellar instability for TT-TG ranged from 0.80 to 0.84 and 0.58 to 0.76 for TT-PCL. Five studies found TT-TG to have more discriminatory power than TT-PCL at distinguishing patients with patellar instability from patients who do not. Sensitivity and specificity ranged from 21 to 85% and 62 to 100%, respectively, for TT-TG. Sensitivity and specificity ranged from 30 to 76% and 46 to 86%, respectively, for TT-PCL. Odds ratio values ranged from 1.06 to 14.02 for TT-TG and 0.98 to 6.47 for TT-PCL. Proposed cutoff TT-TG and TT-PCL values for predicting patellar instability ranged from 15.0 to 21.4 mm and 19.8 to 28.0 mm, respectively. Eight studies reported significant positive correlations between TT-TG and TT-PCL.
TT-TG resulted in overall similar reliability, sensitivity and specificity as TT-PCL; however, TT-TG has better diagnostic accuracy than TT-PCL in the context of patellar instability as per AUC and odds ratio values.
Level IV.
确定胫骨结节-滑车沟（TT-TG）距离与胫骨结节-后十字韧带（TT-PCL）距离的可靠性和诊断准确性，并确定这些测量值在髌股关节不稳定病理诊断中的截断值。
从 MEDLINE、PubMed 和 EMBASE 三个数据库中检索了截至 2022 年 10 月 5 日的文献，以概述髌股关节不稳定患者中 TT-TG 与 TT-PCL 之间的比较。作者遵循 PRISMA 和 R-AMSTAR 指南以及 Cochrane 干预系统评价手册。记录了组内和组间可靠性、受试者工作特征（ROC）曲线参数（如曲线下面积（AUC）、敏感性和特异性）、比值比、病理诊断的截断值以及 TT-TG 和 TT-PCL 之间的相关性。MINORS 评分用于所有研究，以对纳入研究进行质量评估。
本综述共纳入 23 项研究，共计 2839 名患者（2922 个膝关节）。TT-TG 和 TT-PCL 的组内可靠性分别为 0.71-0.98 和 0.55-0.99，组间可靠性分别为 0.74-0.99 和 0.88-0.98。测量 TT-TG 诊断髌股关节不稳定的诊断准确性的 AUC 范围为 0.80-0.84 和 0.58-0.76。五项研究发现 TT-TG 在区分髌股关节不稳定患者和非不稳定患者方面比 TT-PCL 更具鉴别力。TT-TG 的敏感性和特异性分别为 21%-85%和 62%-100%，TT-PCL 的敏感性和特异性分别为 30%-76%和 46%-86%。TT-TG 的比值比范围为 1.06-14.02，TT-PCL 的比值比范围为 0.98-6.47。预测髌股关节不稳定的 TT-TG 和 TT-PCL 截断值范围分别为 15.0-21.4mm 和 19.8-28.0mm。八项研究报告 TT-TG 与 TT-PCL 之间存在显著正相关。
TT-TG 的可靠性、敏感性和特异性与 TT-PCL 总体相似；然而，根据 AUC 和比值比，TT-TG 在髌股关节不稳定方面的诊断准确性优于 TT-PCL。
IV 级。
