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Patellar Tendon–Trochlear Groove Angle Measured on a Single Computed Tomography Slice of the Distal Femoral Trochlear Groove Is a Reliable Measurement for the Evaluation of Patellar Instability

Published:December 14, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.021

      Purpose

      To verify the reliability of patellar tendon–trochlear groove angle (PTTG-A) measured by computed tomography (CT) and the clinical significance in evaluation of patellar instability.

      Methods

      A retrospective study of hospitalized patients with knee pain or injury and had knee CT from January 2017 to June 2021 was performed. PTTG-A and tibial tuberosity–trochlear groove (TT-TG) distance were measured on CT. Spearman correlation analysis was analyzed between the 2 measurements. The intraclass correlation coefficient was determined for inter- and intraobserver reproducibility. The capacity of PTTG-A and TT-TG to predict patellar instability was evaluated by the receiver operating characteristic curve. Data from the control group were used to determine the pathologic thresholds and logistic regression analysis.

      Results

      Included were 113 patients. There were 60 patients with the history of at least 2 episodes of patellar dislocation (study group) and 53 patients without a history of patellar dislocation (control group). The respective PTTG-A and TT-TG distances in the study group (35.2 ± 8.4° and 19.6 ± 4.6 mm) were significantly greater than those of the controls (20.8 ± 5.8° and 13.3 ± 4.5 mm) (P < .001). The correlation between the 2 measurements was strong (r = 0.730, P < .001). The inter- and intraobserver reliability of the PTTG-A were better than TT-TG distance in both groups. The AUC of PTTG-A was greater than that of the TT-TG distance (0.895 vs 0.769, respectively). With the cutoff value of PTTG-A and TT-TG being 26.3° and 16.3 mm, the value of the pathologic threshold of PTTG-A was 30.0°, with a dominance ratio of 16.88 (95% confidence interval 2.88-98.89, P = .002).

      Conclusions

      The PTTG-A measured on a single CT slice of the distal femoral trochlear groove is a more reliable measurement than TT-TG distance for the prediction of patellar instability.

      Level of Evidence

      III; A retrospective cohort study.
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