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. 2023 Nov 9;18(11):e0289259.
doi: 10.1371/journal.pone.0289259. eCollection 2023.

Comparison and interobserver reliability of three different methods for measuring the amount of the tibial tuberosity advancement in the preoperative planning of TTAT

Giovanni Della Valle  1 , Federica Aragosa  1 , Chiara Caterino  1 , Alfonso Piscitelli  2 , Cristina Di Palma  1 , Francesco Lamagna  1 , Gerardo Fatone  1
Affiliations

Comparison and interobserver reliability of three different methods for measuring the amount of the tibial tuberosity advancement in the preoperative planning of TTAT

Giovanni Della Valle et al. PLoS One. .

Abstract

Introduction: The goal of preoperative planning techniques for advancement of the tibial tuberosity is to determine the amount of advancement required to achieve a postoperative patellar tendon angle of 90° and to select the optimal wedge size to achieve this target.

Material and methods: Three radiographic methods for determining the advancement distance for the tibial tuberosity were evaluated for comparability and interobserver reliability. Among the methods developed, we decided to include the common tangent method, the tibial anatomy-based method, and the Bielecki method. For all techniques, radiographs were taken in mediolateral projection with the knee joint flexed at 135°. Three observers with different levels of experience independently evaluated and scored the degree of osteoarthritis for each stifle, as previously described, and performed measurements of the amount of advancement of the tibial tuberosity on 33 stifles using common tangent method, tibial anatomy-based method, and Bielecki method.

Results: According to the results, the overall score for osteoarthritis in the mediolateral view was influenced by the experience of the observers, which contradicts the results from a previous study. Regarding the measurement methods used to assess advancement, poor interobserver reliability was found for common tangent method and Bielecki method, while only a slightly moderate interobserver agreement was found for tibial anatomy-based method.

Discussion: These results are inconsistent with data collected by Bielecki and colleagues. Moreover, measurements from common tangent method and tibial anatomy-based method were overlapping, as confirmed previously. Conversely, Bielecki method showed no agreement with the other methods included in the present study, with a significantly higher mean rank, probably due to its correction formula. Based on the results of the present study, tibial anatomy-based method has better interobserver reliability and is easier to perform according to the observers.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Common tangent (CT) method for the measurement of tibial tuberosity advancement.
Fig 2
Fig 2. Tibial Anatomy-based Method (TAM) for the measurement of tibial tuberosity advancement.
Fig 3
Fig 3. Radiographic landmarks of BM.
Center of the femoral condyle (CF), length of the tibial plateau (B), g: line passing through intercondylar eminence, perpendicular to the tibial plateau; h: line passing through CF, perpendicular to the tibial plateau, distance C detect the subluxation value.
See this image and copyright information in PMC

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