The effect of native knee rotation on the tibial-tubercle-trochlear-groove distance in patients with patellar instability: an analysis of MRI and CT measurements

摘要

Abstract Background This study aimed to quantify the effect of lower limb rotational parameters on the difference in the tibial-tubercle-trochlear-groove (TTTG) distance when assessed with magnetic resonance imaging (MRI) and computed tomography (CT) in patients with patellar instability. It was hypothesized that an increased native knee rotation angle significantly contributes to an underestimation of TTTG by MRI.Methods Forty patients with patellar instability who had undergone standard radiographs, MRI and CT scans were included in this retrospective study. A musculoskeletal radiologist assessed all imaging for TTTG, femoral and tibial rotation, knee rotation and flexion angle, and trochlear dysplasia. ΔTTTG was defined as the TTTG measured on MRI subtracted from the TTTG measured on CT. Statistical analysis determined the effect of these parameters on the calculated difference between TTTG when measured on CT and MRI.Results Equal knee flexion in MRI and CT resulted in a ΔTTTG of 0.1?±?0.3?mm compared to 4.0?±?3.3?mm in patients with different knee flexion angles in both imaging acquisitions (p?=?0.036). The knee rotation angle measured on CT (native knee rotation angle) was negatively correlated with ΔTTTG (r?=???0.365; p?=?0.002), while neither tibial nor femoral rotation showed any associations with TTTG (n.s.). Trochlear dysplasia did not show any significant correlation with ΔTTTG, regardless of classification by Dejour or Lippacher (n.s.). Both the native knee rotation angle and the MRI knee flexion angle were independent predictors of ΔTTTG, yet with an opposing effect (knee rotation: 95% Confidence Interval [CI] for β ??0.468 to ??0.154, p??20° showed a ΔTTTG of ??5.8?±?4.0?mm (MRI rather overestimates TTTG) compared to 0.9?±?4.1?mm Δ TTTG (MRI rather underestimates TTTG) in patients with?