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1 2018

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Tibial tuberosity. Trochlear groove distance in symptom-free young subjects and the proposal for a new guideline value to evaluate patellofemoral pain syndrome in case of trochlea dysplasia

Alk A., Bantle V., Martin T., Wang R., Kasprzyk M., Kozak J.

Medical Robotics Reports

2018

vol. 7

26--30

For the evaluation of the patellofemoral pain syndrome (PFPS) the mediolateral distance between the tibial tuberosity and the trochlear groove (TT-TG) is considered as the gold standard. In this work, we propose to replace the measurement of the TT-TG with conventional tomographic or radiological section images by a smartphone-based mobile sonography system. This new system allows to provide not only ultrasound imaging but also a measuring method for determining the TT-TG using a smartphone as a mobile tracking unit. Moreover, the system supports the diagnosis by acquiring an additional parameter: the mediolateral distance between the intercondylar notch and the tibial tuberosity (TT-IN). The distinctive structure of the intercondylar notch simplifies the examination compared to using the trochlear groove alone. A feasibility study conducted for this paper indicates that this second guideline value is an adequate replacement for the conventional measurement of the TT-TG. Especially in case of trochlea dysplasia the detection and definition of the groove may be difficult and the TT-IN value offers a reasonable alternative. Our study shows that the proposed sonography system is able to accurately determine the TT-TG in a population of symptom-free young subjects. These measurements range from 13.1 ± 4.2 mm for male to 14.8 ± 3.4 mm for female subjects. Our findings correspond to the postulated values of the gold standard. We are able to show that the values for the TT-IN are in a comparable range with 14.4 ± 4.1mm for men and 13.6 ± 4.0 mm for women. We are convinced that this study strongly indicates that the TT-IN is a useful value that is easy to measure with a mobile ultrasound-based measurement system and can provide the same level of diagnostic value compared to the gold standard TT-TG. In conclusion, a new guideline value is presented to complement the measurement of the TT-TG when a pathological anatomy prevents the detection of the groove.