New standardization method of tibial tubercle-posterior cruciate ligament distance according to patient size in patients with patellofemoral instability

Abstract Background Large differences in tibial tubercle–posterior cruciate ligament (TT-PCL) distance were described in several reports between countries, suggesting that abnormal TT-PCL distance is variable due to individual patient size. This study aimed to clarify the relationship between TT-PCL distance and patient size, and to determine a method for describing individualized TT lateralization. Methods We analyzed 41 patients with recurrent patellar dislocation (RPD) and 41 age-matched patients without patellar instability who underwent primary anterior cruciate ligament reconstruction (control). TT-PCL distance and tibia width (TW) were measured based on preoperative T2-weighted magnetic resonance imaging. Then, TT-PCL distance was standardized based on TW (TT-PCL ratio), and TT-PCL distance and ratio were compared between groups. Correlations were investigated among TT-PCL distance, TT-PCL ratio and each measurement (patient height, weight, TW). Results Strong positive correlations were observed between TW and patient height, and weak or moderate positive correlations were found between TT-PCL distance and each parameter. The mean TT-PCL distance was 21.2 and 20.6 mm (P = .39), while the mean TT-PCL ratio was 31.6% and 29.0% (P = .0093) in the RPD and control groups, respectively. The TT-PCL ratio was Conclusions Our findings demonstrate that the TT-PCL ratio is not affected by patient size, although the TT-PCL distance is associated with knee size and patient height. The TT-PCL ratio could be an important index for identifying patients for whom distal realignment surgery should be considered.