The Experts below are selected from a list of 5361 Experts worldwide ranked by ideXlab platform
Andrew J. Cosgarea - One of the best experts on this subject based on the ideXlab platform.
-
Tibial Tuberosity anteriomedialization vs medial patellofemoral ligament reconstruction for treatment of patellar instability related to malalignment computational simulation
Clinical Biomechanics, 2020Co-Authors: Joh J Elias, Kerwy C Jones, Miho J Tanaka, Andrew J. CosgareaAbstract:Abstract Background Medial patellofemoral ligament reconstruction and Tibial Tuberosity anteromedialization are common treatment options for recurrent lateral patellar instability, although ligament reconstruction is not commonly applied to knees with lateral malalignment. Methods Multibody dynamic simulation was used to assess knee function following Tibial Tuberosity anteromedialization and medial patellofemoral ligament reconstruction for knees with lateral malalignment. Dual limb squatting was simulated with six models representing knees being treated for patellar instability with an elevated Tibial Tuberosity to trochlear groove distance. The patellar tendon attachment on the tibia was shifted medially (10 mm) and anteriorly (5 mm) to represent Tibial Tuberosity anteromedialization. A hamstrings tendon graft was represented for medial patellofemoral ligament reconstruction. Patellar tracking was quantified based on bisect offset index. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures comparisons with post-hoc tests. Findings Both procedures significantly reduced bisect offset index, primarily at low flexion angles. The decrease was larger for Tibial Tuberosity anteromedialization, peaking at 0.18. Tibial Tuberosity anteromedialization shifted contact pressures medially, significantly increasing the maximum medial contact pressure at multiple flexion angles, with the maximum pressure increasing up to 1 MPa. Interpretation The results indicate Tibial Tuberosity anteromedialization decreases lateral patellar maltracking more effectively than medial patellofemoral ligament reconstruction, but shifts contact pressure medially. Tibial Tuberosity anteromedialization is likely to reduce the risk of post-operative instability compared to medial patellofemoral ligament reconstruction. The medial shift in the pressure distribution should be considered for knees with medial cartilage lesions, however.
-
anteroposterior distance between the Tibial Tuberosity and trochlear groove in patients with patellar instability
Knee, 2019Co-Authors: Miho J Tanaka, Joh J Elias, Gaurav K Thawai, Shadpou Demehri, Taylo Damore, Andrew J. CosgareaAbstract:Abstract Background Our objective was to describe a measurement to assess sagittal Tibial Tuberosity (TT)–trochlear groove (TG) distance and to compare this between asymptomatic (control) patients and patients with symptomatic patellar instability. Methods We compared static CT images of 22 fully extended knees of patients with symptomatic patellar instability with images of 22 asymptomatic knees. TT–TG distance was measured to quantify lateralization of the TT, and anteroposterior TT–TG distance was used to quantify the sagittal distance between these two points. Lateral trochlear inclination, sulcus angle, and trochlear depth were measured. Groups were compared using paired t tests (alpha = 0.05). Correlations of anteroposterior TT–TG distance with lateral trochlear inclination, sulcus angle, and trochlear depth were assessed using linear and multivariate regression. Results Mean TT–TG distances were 19.9 ± 4.4 mm (symptomatic) and 16.8 ± 5.5 mm (control) (mean ± std deviation) (P = 0.002). Mean anteroposterior TT–TG distances were 8.3 ± 7.8 mm (symptomatic) and − 0.5 ± 4.6 mm (control) (P Conclusions In asymptomatic patients, the anteroposterior TT–TG distance was − 0.5 mm, indicating that the TG and TT were nearly in the same coronal plane. In patients with symptomatic patellar instability, the TG was almost nine millimeters anterior, and this distance correlated with measurements of trochlear dysplasia. Level of evidence III, case control study.
-
computational simulation of medial versus anteromedial Tibial Tuberosity transfer for patellar instability
Journal of Orthopaedic Research, 2018Co-Authors: Joh J Elias, Kerwy C Jones, Andrew J Copa, Andrew J. CosgareaAbstract:The study utilizes dynamic simulation of knee function to determine how Tibial Tuberosity medialization and anteromedialization influence patellar tracking and contact pressures for knees with patellar instability. Dual limb squatting was simulated with six multibody dynamic simulation models representing knees being treated for patellar instability. Each knee exhibited lateral patellar maltracking in the pre-operative condition based on the bisect offset index. The patellar tendon attachment points on the tibia were medialized by 10 mm to represent Tibial Tuberosity medialization, with an additional 5 mm of anteriorization applied for anteromedialization. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures analysis of variance with post-hoc tests and linear regressions. Tibial Tuberosity medialization and anteromedialization significantly (p < 0.05) decreased the bisect offset index for nearly all flexion angles up to 80°, with the largest changes near full extension. Both procedures significantly decreased the maximum lateral pressure at 55°, but increased the maximum medial pressure from 30 to 80°. The pre-operative to post-operative increase in the maximum contact pressure was significantly correlated with the maximum pre-operative bisect offset index for Tuberosity medialization (r2 = 0.84), but not for anteromedialization. Statement of Clinical Significance: The results indicate Tibial Tuberosity medialization decreases patellar lateral maltracking and lateral patellofemoral contact pressures, but increases medial contact pressures. When pre-operative patellar maltracking is relatively low, Tibial Tuberosity medialization is likely to increase maximum contact pressures. Tibial Tuberosity anteromedialization lowers the risk of elevated post-operative contact pressures compared to medialization. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3231-3238, 2018.
-
Tibial Tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis related structural damage worsening data from the osteoarthritis initiative
European Radiology, 2018Co-Authors: Arya Hajmirzaia, Andrew J. Cosgarea, Miho J Tanaka, Ali Guermazi, M Hakky, Christophe Sereni, Ashi Zikria, Frank W Roeme, Shadpou DemehriAbstract:To determine whether the Tibial Tuberosity-to-trochlear groove (TT-TG) distance is associated with concurrent patellofemoral joint osteoarthritis (OA)-related structural damage and its worsening on 24-month follow-up magnetic resonance imaging (MRI) in participants in the Osteoarthritis Initiative (OAI). Six hundred subjects (one index knee per participant) were assessed. To evaluate patellofemoral OA-related structural damage, baseline and 24-month semiquantitative MRI Osteoarthritis Knee Score (MOAKS) variables for cartilage defects, bone marrow lesions (BMLs), osteophytes, effusion, and synovitis were extracted from available readings. The TT-TG distance was measured in all subjects using baseline MRIs by two musculoskeletal radiologists. The associations between baseline TT-TG distance and concurrent baseline MOAKS variables and their worsening in follow-up MRI were investigated using regression analysis adjusted for variables associated with tibiofemoral and patellofemoral OA. At baseline, increased TT-TG distance was associated with concurrent lateral patellar and trochlear cartilage damages, BML, osteophytes, and knee joint effusion [cross-sectional evaluations; overall odds ratio 95% confidence interval (OR 95% CI): 1.098 (1.045–1.154), p < 0.001]. In the longitudinal analysis, increased TT-TG distance was significantly related to lateral patellar and trochlear cartilage, BML, and joint effusion worsening (overall OR 95% CI: 1.111 (1.056–1.170), p < 0.001). TT-TG distance was associated with simultaneous lateral patellofemoral OA-related structural damage and its worsening over 24 months. Abnormally lateralized Tibial Tuberosity may be considered as a risk factor for future patellofemoral OA worsening. • Excessive TT-TG distance on MRI is an indicator/predictor of lateral-patellofemoral-OA. • TT-TG is associated with simultaneous lateral-patellofemoral-OA (6–17% chance-increase for each millimeter increase). • TT-TG is associated with longitudinal (24-months) lateral-patellofemoral-OA (5–15% chance-increase for each millimeter).
-
complications of Tibial Tuberosity osteotomy
Sports Medicine and Arthroscopy Review, 2017Co-Authors: Ale A Johnso, Andrew J. Cosgarea, Elizabeth L WolfeAbstract:It is important to understand potential complications of Tibial Tuberosity osteotomies (TTOs) and how to avoid them. TTO is associated with a 1% to 3% rate of Tibial fracture and 1% rate of nonunion. Early weight-bearing and complete detachment of the distal Tuberosity may increase these risks. Painful screws requiring removal occur in 3% to 77% of cases. Use of small (3.5- mm diameter), countersunk screws reduces this risk. Recurrent instability occurs in ∼5% of cases at 5 years. The risk of deep-vein thrombosis (4%) after TTO is higher than that associated with other sports surgeries (1% to 2%). The risk of wound complications is ∼1% and can be reduced with meticulous handling of soft tissues and avoidance of large medial incisions. The risk of deep infection is <1%. Severe complications such as compartment syndrome and pulmonary embolism are rare.
Sandro F Fucentese - One of the best experts on this subject based on the ideXlab platform.
-
combined correction of Tibial torsion and Tibial Tuberosity trochlear groove distance by supratuberositary torsional osteotomy of the tibia
American Journal of Sports Medicine, 2020Co-Authors: Lukas Jud, Sarvpree Singh, Timo Tondelli, Philipp Furnstahl, Sandro F Fucentese, Lazaros VlachopoulosAbstract:Background:Increased external Tibial torsion and Tibial Tuberosity–trochlear groove distance (TTTG) affect patellofemoral instability and can be corrected by Tibial rotational osteotomy and Tibial ...
-
end stage extension of the knee and its influence on Tibial Tuberosity trochlear groove distance tttg in asymptomatic volunteers
Knee Surgery Sports Traumatology Arthroscopy, 2014Co-Authors: Tobias J Dietrich, Michael Etz, Christia W A Pfirrma, Pete P Koch, Sandro F FucenteseAbstract:Purpose Increased Tibial Tuberosity-trochlear groove distance (TTTG) is one potential correcting parameter in patients suffering from lateral patellar instability. It was hypothesized that end-stage extension of the knee might influence the TTTG distance on MR images.
-
the Tibial Tuberosity trochlear groove distance a comparative study between ct and mri scanning
Knee, 2006Co-Authors: Philip Schoettle, Sandro F Fucentese, Christia W A Pfirrma, Marco Zanetti, Urka Seife, Jose RomeroAbstract:CT scan is the gold standard for the measurement of the Tibial Tuberosity-trochlear groove distance (TTTG). The aim of this study was to evaluate the reliability of the TTTG on MRI compared to CT scan. Twelve knees in 11 patients underwent CT and MRI examination for patellofemoral instability or anterior knee pain. Both the bony and the cartilaginous landmarks of the trochlear groove were used for the measurement of the TTTG. The measurements were performed by two experienced musculoskeletal radiologists. The interrater, intermethod and interperiod reliability was calculated using a restricted maximum likelihood estimation and a Bland-Altman analysis. The mean TTTG referenced on bony landmarks was 14.4+/-5.4 mm on CT scans, and 13.9+/-4.5 mm on MR images. The mean TTTG referenced on cartilaginous landmarks was 15.3+/-4.1 mm on CT scans, and 13.5+/-4.6 mm on MR images. An excellent interrater (82%), intermethods (86%), and interperiod (91%) quantitative reliability was found. TTTG can be determined reliably on MRI using either cartilage or bony landmarks. Additional CT scans are not necessary.
Joh J Elias - One of the best experts on this subject based on the ideXlab platform.
-
Tibial Tuberosity anteriomedialization vs medial patellofemoral ligament reconstruction for treatment of patellar instability related to malalignment computational simulation
Clinical Biomechanics, 2020Co-Authors: Joh J Elias, Kerwy C Jones, Miho J Tanaka, Andrew J. CosgareaAbstract:Abstract Background Medial patellofemoral ligament reconstruction and Tibial Tuberosity anteromedialization are common treatment options for recurrent lateral patellar instability, although ligament reconstruction is not commonly applied to knees with lateral malalignment. Methods Multibody dynamic simulation was used to assess knee function following Tibial Tuberosity anteromedialization and medial patellofemoral ligament reconstruction for knees with lateral malalignment. Dual limb squatting was simulated with six models representing knees being treated for patellar instability with an elevated Tibial Tuberosity to trochlear groove distance. The patellar tendon attachment on the tibia was shifted medially (10 mm) and anteriorly (5 mm) to represent Tibial Tuberosity anteromedialization. A hamstrings tendon graft was represented for medial patellofemoral ligament reconstruction. Patellar tracking was quantified based on bisect offset index. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures comparisons with post-hoc tests. Findings Both procedures significantly reduced bisect offset index, primarily at low flexion angles. The decrease was larger for Tibial Tuberosity anteromedialization, peaking at 0.18. Tibial Tuberosity anteromedialization shifted contact pressures medially, significantly increasing the maximum medial contact pressure at multiple flexion angles, with the maximum pressure increasing up to 1 MPa. Interpretation The results indicate Tibial Tuberosity anteromedialization decreases lateral patellar maltracking more effectively than medial patellofemoral ligament reconstruction, but shifts contact pressure medially. Tibial Tuberosity anteromedialization is likely to reduce the risk of post-operative instability compared to medial patellofemoral ligament reconstruction. The medial shift in the pressure distribution should be considered for knees with medial cartilage lesions, however.
-
anteroposterior distance between the Tibial Tuberosity and trochlear groove in patients with patellar instability
Knee, 2019Co-Authors: Miho J Tanaka, Joh J Elias, Gaurav K Thawai, Shadpou Demehri, Taylo Damore, Andrew J. CosgareaAbstract:Abstract Background Our objective was to describe a measurement to assess sagittal Tibial Tuberosity (TT)–trochlear groove (TG) distance and to compare this between asymptomatic (control) patients and patients with symptomatic patellar instability. Methods We compared static CT images of 22 fully extended knees of patients with symptomatic patellar instability with images of 22 asymptomatic knees. TT–TG distance was measured to quantify lateralization of the TT, and anteroposterior TT–TG distance was used to quantify the sagittal distance between these two points. Lateral trochlear inclination, sulcus angle, and trochlear depth were measured. Groups were compared using paired t tests (alpha = 0.05). Correlations of anteroposterior TT–TG distance with lateral trochlear inclination, sulcus angle, and trochlear depth were assessed using linear and multivariate regression. Results Mean TT–TG distances were 19.9 ± 4.4 mm (symptomatic) and 16.8 ± 5.5 mm (control) (mean ± std deviation) (P = 0.002). Mean anteroposterior TT–TG distances were 8.3 ± 7.8 mm (symptomatic) and − 0.5 ± 4.6 mm (control) (P Conclusions In asymptomatic patients, the anteroposterior TT–TG distance was − 0.5 mm, indicating that the TG and TT were nearly in the same coronal plane. In patients with symptomatic patellar instability, the TG was almost nine millimeters anterior, and this distance correlated with measurements of trochlear dysplasia. Level of evidence III, case control study.
-
computational simulation of medial versus anteromedial Tibial Tuberosity transfer for patellar instability
Journal of Orthopaedic Research, 2018Co-Authors: Joh J Elias, Kerwy C Jones, Andrew J Copa, Andrew J. CosgareaAbstract:The study utilizes dynamic simulation of knee function to determine how Tibial Tuberosity medialization and anteromedialization influence patellar tracking and contact pressures for knees with patellar instability. Dual limb squatting was simulated with six multibody dynamic simulation models representing knees being treated for patellar instability. Each knee exhibited lateral patellar maltracking in the pre-operative condition based on the bisect offset index. The patellar tendon attachment points on the tibia were medialized by 10 mm to represent Tibial Tuberosity medialization, with an additional 5 mm of anteriorization applied for anteromedialization. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures analysis of variance with post-hoc tests and linear regressions. Tibial Tuberosity medialization and anteromedialization significantly (p < 0.05) decreased the bisect offset index for nearly all flexion angles up to 80°, with the largest changes near full extension. Both procedures significantly decreased the maximum lateral pressure at 55°, but increased the maximum medial pressure from 30 to 80°. The pre-operative to post-operative increase in the maximum contact pressure was significantly correlated with the maximum pre-operative bisect offset index for Tuberosity medialization (r2 = 0.84), but not for anteromedialization. Statement of Clinical Significance: The results indicate Tibial Tuberosity medialization decreases patellar lateral maltracking and lateral patellofemoral contact pressures, but increases medial contact pressures. When pre-operative patellar maltracking is relatively low, Tibial Tuberosity medialization is likely to increase maximum contact pressures. Tibial Tuberosity anteromedialization lowers the risk of elevated post-operative contact pressures compared to medialization. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3231-3238, 2018.
-
variations in Tibial Tuberosity to trochlear groove and posterior cruciate ligament distances due to Tibial external and valgus rotations
Journal of Knee Surgery, 2017Co-Authors: Adley W Smith, Kerwy C Jones, Emily A Milla, Joh J EliasAbstract:Tibial rotations with respect to the femur influence measurements used to assess the lateral position of the Tibial Tuberosity. This study utilized computational modeling to quantify how the Tibial Tuberosity to trochlear groove (TT-TG) and Tibial Tuberosity to posterior cruciate ligament attachment (TT-PCL) distances vary with Tibial internal/external and varus/valgus rotations. Computational models were developed from magnetic resonance imaging data to represent eight knees with patellar instability. TT-TG and TT-PCL distances were quantified from the computational models for a neutral orientation and with the tibia rotated internally and externally and into varus and valgus in 1-degree increments to 5 degrees. Regression analyses related Tibial rotations to TT-TG and TT-PCL distances. TT-TG distance increased with Tibial external rotation, and both TT-TG and TT-PCL distances increased with valgus orientation (r 2 > 0.94 for all regressions). The average increase in TT-TG distance for each 1 degree of Tibial external rotation was 0.55 mm (range: 0.50–0.62 mm), compared with 0.00 mm (range: −0.05 to 0.04 mm) for TT-PCL distance. The average increase in TT-TG distance for each 1 degree of valgus was 1.01 mm (range: 0.91–1.14 mm), compared with 0.46 mm (range: 0.32–0.60 mm) for TT-PCL distance. TT-TG distance varies more with Tibial rotations than TT-PCL distance due to both points being on the tibia and a smaller proximal–distal distance between the points for TT-PCL distance.
-
biomechanical analysis of Tibial Tuberosity medialization and medial patellofemoral ligament reconstruction
Sports Medicine and Arthroscopy Review, 2017Co-Authors: Joh J Elias, Adley W Smith, Lake T DaneyAbstract:Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and Tibial Tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and Tibial Tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft overtensioning and nonanatomic attachment on the femur leading to overconstraint of the patella and elevated medial contact pressures. For Tuberosity medialization, the influence of altered tibiofemoral kinematics on postoperative function is unknown. Future biomechanical studies should emphasize inclusion of anatomic features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.
Deiary F Kade - One of the best experts on this subject based on the ideXlab platform.
-
is Tibial Tuberosity trochlear groove distance an appropriate measure for the identification of knees with patellar instability
Knee Surgery Sports Traumatology Arthroscopy, 2014Co-Authors: Nick Capla, Deborah Lees, M Newby, Alistai Ewe, Robe Jackso, A St Clair Gibso, Deiary F KadeAbstract:Purpose Tibial Tuberosity–trochlear groove distance (TT–TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT–TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT–TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability.
-
the relationship between quadriceps angle and Tibial Tuberosity trochlear groove distance in patients with patellar instability
Knee Surgery Sports Traumatology Arthroscopy, 2012Co-Authors: A D Cooney, Nick Capla, M Newby, A St Clair Gibso, Z Kazi, Deiary F KadeAbstract:Purpose The quadriceps angle (Q-angle) represents the angle between the vector of action of the quadriceps and the patellar tendon. An increased Q-angle has been associated with an increased risk of patellar instability, although there is disagreement on its reliability and validity as it is affected by the position of the limb and contraction of the quadriceps. Tibial Tuberosity–trochlear groove distance (TT–TG) is ascertained by axial CT scanning, with an increased value associated with patellar instability. This study aimed to determine whether the Q-angle correlates with the TT–TG distance in patients with patellar instability.
Lazaros Vlachopoulos - One of the best experts on this subject based on the ideXlab platform.
-
combined correction of Tibial torsion and Tibial Tuberosity trochlear groove distance by supratuberositary torsional osteotomy of the tibia
American Journal of Sports Medicine, 2020Co-Authors: Lukas Jud, Sarvpree Singh, Timo Tondelli, Philipp Furnstahl, Sandro F Fucentese, Lazaros VlachopoulosAbstract:Background:Increased external Tibial torsion and Tibial Tuberosity–trochlear groove distance (TTTG) affect patellofemoral instability and can be corrected by Tibial rotational osteotomy and Tibial ...
