Keywords:
Musculoskeletal system, Musculoskeletal joint, MR, PACS, Image compression, Developmental disease, Education and training
Authors:
L. Aghaghazvini, M. Tahmasebi, H. Sheidaee, S. Mirkarimi, M. Shakiba; Tehran/IR
DOI:
10.26044/ecr2019/C-3058
Conclusion
In a study recently conducted by Carlson et al,
TT-TGD was measured in patients with PFPS by MRI.
In this study,
the mean TT-TGD was higher in the patients group than in the control group.
Also,
30% of the patient group had TT-TGD higher than 15 mm (19).
In another study conducted by Wittstein et al with the aid of MRI,
it was shown that TT-TGD in the PFPS group was higher than that of the healthy group.
The findings were consistent with our study results.
However,
the main problem of that study was that it was done with a small sample size (20).
It has been shown that a slight displacement of Tibial tuberosity to the lateral side causes patellar maltracking and an increase in contact pressure in the patellofemoral joint (18).
Our study showed that lateralization in the tibial tuberosity causes imbalance in the knee extensor mechanism forces Therefore,
we recommend measuring TT-TGD using MRI in patients with treatment-resistant PFPS.
Non-surgical treatments that are used for PFPS often include the strengthening of quadriceps muscle and patellar taping.
Conservative treatment often improve patellar tracking and reduce pain by balancing knee posture.
However,
some patients do not respond to treatment.
According to the findings of this study and previous studies an increase in TT-TGD might justify part of the PFPS-resistant cases (19- 20).
One of the strengths of this study was that the patient group fully included patients with PFPS and all suspected cases of patellar instability were excluded.
The biggest weakness of the study was that the control group was not composed of healthy people.
We propose that the increase of TT-TGD should be considered one of the factors influencing the development of PFPS.
As far as we know,
there are few studies comparing TT-TGD between healthy people and those with PFPS,
thus more studies are needed to determine the prevalence of tibial tuberosity lateralization among people with PFPS.
Considering the advantages of MRI in detecting cartilage lesions and soft tissue,
the use of this diagnostic modality instead of CT scan to measure TT-TGD is recommended however there is a need for future studies to measure TT-TGD in varying degrees of knee flexion,
among patients with PFPS.
In summary:
The TT-TGD mean in patients with PFPS was greater than that in the control group.
An increase in TT-TGD can be considered one of the factors behind the development of PFPS,
therefore,
Measurement of TT-TGD using MRI should be performed as part of the evaluation of PFPS-resistant cases.