Skip to main content
Log in

CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

  • Articles
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Anterior knee pain is commonly associated with patellofemoral malalignment. Both conventional radiographic measurements and CT measurements have been proposed to define and confirm the sometimes difficult clinical diagnosis of anterior knee pain secondary to patellofemoral malalignment. Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n=50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n=10) and with the knees of asymptomatic controls (n=10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2±0.5 mm) than did the asymptomatic knee (9.0±0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9±0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4±0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shea KP, Fulkerson JP. Preoperative computed tomography scanning and arthroscopy in predicting outcome after lateral retinacular release. Arthroscopy 1992; 8: 327–334.

    Google Scholar 

  2. Ghelman B, Hodge JC. Imaging of the patellofemoral joint. Orthop Clin North Am 1992; 23: 523–543.

    Google Scholar 

  3. Judet J, Judet H, Massare C. Le scanner dans l'exploration des malpositions rotulieness. Chirurgie 1979; 105: 535–539.

    Google Scholar 

  4. Martinez S, Korobkin M, Fondren FB, Hedlund LW, Goldner JL. Diagnosis of patellofemoral malalignment by computed tomography. J Comput Assist Tomogr 1983; 7: 1050–1053.

    Google Scholar 

  5. Minkoff J, Fein L. The role of radiography in the evaluation and treatment of common anarthrotic disorders of the patellofemoral joint. Clin Sports Med 1989; 8: 203–260.

    Google Scholar 

  6. Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am 1986; 17: 235–248.

    Google Scholar 

  7. Laurin CA, Dussault R, Levesque HP. The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Clin Orthop 1979; 144: 16–26.

    Google Scholar 

  8. Martinez S, Korobkin M, Fondren FB, Hedlund LW, Goldner JL. Computed tomography of the normal patellofemoral joint. Invest Radiol 1983; 18: 249–253.

    Google Scholar 

  9. Reikeras O. Patellofemoral characteristics in patients with increased femoral anteversion. Skeletal Radiol 1992; 21: 311–313.

    Google Scholar 

  10. Schutzer SF, Ramsby GR, Fulkerson JP. The evaluation of patellofemoral pain using computerized tomography. Clin Orthop 1986; 204: 286–288.

    Google Scholar 

  11. Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA. Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 1987; 3: 19–24.

    Google Scholar 

  12. Muneta T, Yamamoto H, Ishibashi T, Asahina S, Furuya K. Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint. Am J Sports Med 1994; 22: 67–71.

    Google Scholar 

  13. Fulkerson JP, Hungerford DS. Disorders of the patellofemoral joint, 2nd edn. Baltimore: Williams & Wilkins, 1990: 71–83, 111, 179, 206.

    Google Scholar 

  14. Delgado-Martins H. A study of the position of the patella using computerized tomography. J Bone Joint Surg [Br] 1979; 61: 443–444.

    Google Scholar 

  15. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop 1983; 177: 176–181.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jones, R.B., Bartlett, E.C., Vainright, J.R. et al. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain. Skeletal Radiol. 24, 505–509 (1995). https://doi.org/10.1007/BF00202146

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00202146

Key words

Navigation