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. 2023 Feb 16;59(2):382.
doi: 10.3390/medicina59020382.

Femoral Anteversion Measured by the Surgical Transepicondylar Axis Is Correlated with the Tibial Tubercle-Roman Arch Distance in Patients with Lateral Patellar Dislocation

Jiaxing Chen  1   2 , Fuling Chen  1   3 , Lin Fan  1   2 , Sizhu Liu  4 , Yi Feng  5 , Qiaochu Li  1   2 , Jian Zhang  1   2 , Zhengxue Quan  1   2 , Aiguo Zhou  1   2
Affiliations

Femoral Anteversion Measured by the Surgical Transepicondylar Axis Is Correlated with the Tibial Tubercle-Roman Arch Distance in Patients with Lateral Patellar Dislocation

Jiaxing Chen et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Various predisposing factors for lateral patellar dislocation (LPD) have been identified, but the relation between femoral rotational deformity and the tibial tubercle-Roman arch (TT-RA) distance remains elusive. Materials and Methods: We conducted this study including 72 consecutive patients with unilateral LPD. Femoral anteversion was measured by the surgical transepicondylar axis (S-tAV), and the posterior condylar reference line (P-tAV), TT-RA distance, trochlear dysplasia, knee joint rotation, patellar height, and hip-knee-ankle angle were measured by CT images or by radiographs. The correlations among these parameters were analyzed, and the parameters were compared between patients with and without a pathological TT-RA distance. Binary regression analysis was performed, and receiver operating characteristic curves were obtained. Results: The TT-RA distance was correlated with S-tAV (r = 0.360, p = 0.002), but the correlation between P-tAV and the TT-RA distance was not significant. S-tAV had an AUC of 0.711 for predicting a pathological TT-RA, with a value of >18.6° indicating 54.8% sensitivity and 82.9% specificity. S-tAV revealed an OR of 1.13 (95% CI [1.04, 1.22], p = 0.003) with regard to the pathological TT-RA distance by an adjusted regression model. Conclusions: S-tAV was significantly correlated with the TT-RA distance, with a correlation coefficient of 0.360, and was identified as an independent risk factor for a pathological TT-RA distance. However, the TT-RA distance was found to be independent of P-tAV.

Keywords: TT-RA distance; femoral anteversion; patellar dislocation; surgical transepicondylar axis; tibial tubercle osteotomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Segmental femoral torsion parameters. (A) An axial CT slice showing the intact femoral head and neck is selected. The two circles were drawn to the margin of femoral head and neck to identify the center of the head and neck; Line a passes through the center of both the femoral head and the neck. (B) Distal femoral shaft line (Line b) is tangent to the posterior bony margin of the femoral shaft on the slice above the gastrocnemius insertion. (C) An axial slice showing an intact “Roman Arch” and the femoral condyles. The posterior condylar reference line (PCRL) was drawn tangent to the posterior femoral condyles; the surgical transepicondylar axis (SEA) passes through the sulcus of the medial epicondyle and the prominence of the lateral epicondyle.
Figure 2
Figure 2
Lateral trochlea inclination (LTI). An axial slice showing an intact “Roman Arch” and the femoral condyles. The posterior condylar reference line (PCRL), its parallel line (the red dotted line), and a tangent line of the lateral trochlear facet (LTF) are shown. The LTI is defined as the angle between the PCRL and the LTF.
Figure 3
Figure 3
Tibial tubercle to Roman arch (TT-RA) distance. (A) The PCRL was drawn tangent to the posterior femoral condyles, and its parallel line (the doted one) was tangent to the Roman arch; a line perpendicular to the PCRL was drawn to pass through the tangent point (RAL). (B) The center of the tibial tuberosity (TT) is marked on an axial CT slice at the insertion of the patellar tendon. (C) After superimposing the two images, the line parallel to the RAL was drown through the TT (TTL). The TT-RA distance is defined as the distance between the RAL and the TTL.
Figure 4
Figure 4
Hip–knee–ankle (HKA) angle measured by a weight-bearing full-leg radiograph. The points represent the center of the femoral head (a), the femoral condyles (b), the tibial plateau (c), and the ankle joint (d). It is the angle formed between the femoral axis (ab) and the tibial axis (cd).
Figure 5
Figure 5
Receiver operating characteristic curve (ROC) of S-tAV (A) and P-tAV (B) for a pathological TT-RA distance. The areas under the curves (AUC) and the p values are shown.
Figure 6
Figure 6
Binary regression model for a pathological tibial tubercle–Roman arch distance. The odds ratio, 95% confidence interval, and p values are shown.
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References

    1. Song Y.F., Wang H.J., Yan X., Yuan F.Z., Xu B.B., Chen Y.R., Ye J., Fan B.S., Yu J.K. Tibial Tubercle Osteotomy May not Provide Additional Benefit in Treating Patellar Dislocation with Increased Tibial Tuberosity-Trochlear Groove Distance: A Systematic Review. Arthroscopy. 2021;37:1670–1679.e1671. doi: 10.1016/j.arthro.2020.12.210. - DOI - PubMed
    1. Levy B.J., Tanaka M.J., Fulkerson J.P. Current Concepts Regarding Patellofemoral Trochlear Dysplasia. Am. J. Sports. Med. 2021;49:1642–1650. doi: 10.1177/0363546520958423. - DOI - PubMed
    1. Yang G., Dai Y., Dong C., Kang H., Niu J., Lin W., Wang F. Distal femoral morphological dysplasia is correlated with increased femoral torsion in patients with trochlear dysplasia and patellar instability. Bone Jt. J. 2020;102-b:868–873. doi: 10.1302/0301-620X.102B7.BJJ-2019-1331.R1. - DOI - PubMed
    1. Xu Z., Zhang H., Chen J., Mohamed S.I., Zhou A. Femoral Anteversion is Related to Tibial Tubercle-Trochlear Groove Distance in Patients with Patellar Dislocation. Arthroscopy. 2020;36:1114–1120. doi: 10.1016/j.arthro.2019.10.033. - DOI - PubMed
    1. Noonan B., Cooper T., Chau M., Albersheim M., Arendt E.A., Tompkins M. Rotational Deformity-When and How to Address Femoral Anteversion and Tibial Torsion. Clin. Sports Med. 2022;41:27–46. doi: 10.1016/j.csm.2021.07.011. - DOI - PubMed

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