{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:05:08Z","timestamp":1789286708276,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To assess the interobserver reliability of the assessment of the tibial tubercle\u2010trochlear groove (TT\u2010TG) distance, tibial tubercle\u2010Roman arch (TT\u2010RA) distance, tibial tubercle\u2010midepicondyle (TT\u2010ME) distance, and tibial tubercle\u2010posterior cruciate ligament (TT\u2010PCL) distance; to compare the diagnostic value of imaging parameters for detecting pathological tibial tubercle lateralization; and to analyze whether the TT\u2010PCL distance has diagnostic value.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients with patellar dislocation and with meniscus injury or anterior cruciate ligament injury admitted to our hospital from January 2019 to July 2025 were retrospectively reviewed. The TT\u2010TG distance, TT\u2010RA distance, TT\u2010ME distance, and TT\u2010PCL distance between the meniscus injury or anterior cruciate ligament injury (control group) and patellar dislocation (case group) were compared using the unpaired\n t<\/jats:italic>\n \u2010test or Mann\u2010Whitney U test. The receiver operating characteristic curve was used to calculate the area under the curve, diagnostic threshold, sensitivity, and specificity for the TT\u2010TG distance, TT\u2010RA distance, and TT\u2010ME distance. Three observers measured all parameters, and the intraclass correlation coefficient (ICC) was used to assess interobserver reliability.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Magnetic resonance imaging was obtained from 50 patients with the clinical diagnosis of patellar dislocation and from 50 patients with meniscus injury or anterior cruciate ligament injury. Regarding age, sex, and side of injury, there were no statistically significant differences between the 2 groups (\n P<\/jats:italic>\n \u2009>\u2009.05). The TT\u2010TG distance [(18.02\u2009\u00b1\u20093.02)\u2009mm], TT\u2010RA distance [(21.49\u2009\u00b1 3.67)\u2009mm], and TT\u2010ME distance [(15.63\u2009\u00b1\u20093.88)\u2009mm] in the case group were significantly different from the TT\u2010TG distance [(10.52\u2009\u00b1\u20093.00)\u2009mm], TT\u2010RA distance [(14.18\u2009\u00b1\u20093.30)\u2009mm], and TT\u2010ME distance [(8.85\u2009\u00b1\u20093.37)\u2009mm] in the control group (\n P<\/jats:italic>\n \u2009<\u2009.001). The TT\u2010PCL distance, however, showed no statistically significant difference between the groups: 21.45 (18.87, 22.76) mm (cases) versus 20.02 (18.29, 22.67) mm (controls) (\n P<\/jats:italic>\n \u2009>\u2009.05). The area under the curve was 0.965 for the TT\u2010TG distance, 0.936 for the TT\u2010RA distance, and 0.904 for the TT\u2010ME distance. All interobserver reliability ICC values for the TT\u2010TG distance were greater than 0.75; all interobserver reliability ICC values for the TT\u2010RA distance were greater than 0.85, and all interobserver reliability ICC values for the TT\u2010ME distance were greater than 0.85.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The TT\u2010TG distance has lower interobserver reliability than the TT\u2010RA and TT\u2010ME distances. The TT\u2010PCL distance does not differ between patients with patellar dislocation and those without.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective comparative case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70542","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T07:34:56Z","timestamp":1789284896000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Tibial Tubercle\u2010Trochlear Groove Distance Has Higher Accuracy and Moderate Inter\u2010observer Reliability Compared With the Tibial Tubercle\u2010Roman Arch and Tibial Tubercle\u2010Midepicondyle Distances"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1992-9914","authenticated-orcid":false,"given":"Yiheng","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zejun","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Tangshan People's Hospital Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"},{"name":"Graduate School of North China University of Science and Technology Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junran","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bokai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Tangshan Tangshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00167-022-07119-8","article-title":"CT and MRI measurements of tibial tubercle lateralization in patients with patellar dislocation were not equivalent but could be interchangeable","volume":"31","author":"Xu Z","year":"2023","journal-title":"Knee Surg Sports Traumatol 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tubercle in recurrent patellar dislocation","volume":"22","author":"Su P","year":"2021","journal-title":"BMC Musculoskelet Disord."},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.2106\/JBJS.17.00863","article-title":"Lateralization of the tibial tubercle in recurrent patellar dislocation: Verification using multiple methods to evaluate the tibial tubercle","volume":"100","author":"Tensho K","year":"2018","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/0363546515602483","article-title":"Individualizing the tibial tubercle\u2010trochlear groove distance: Patellar instability ratios that predict recurrent instability","volume":"44","author":"Camp CL","year":"2016","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_8_1","first-page":"232596712091487","article-title":"Tibial tubercle\u2010roman arch distance: A new measurement of patellar dislocation and indication of tibial tubercle osteotomy","volume":"8","author":"Xu Z","year":"2020","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_7_9_1","first-page":"232596712211185","article-title":"Reliability of the tibial tubercle\u2010roman arch distance for evaluating tibial tubercle malposition and predicting patellar dislocation via magnetic resonance imaging","volume":"10","author":"Xu Z","year":"2022","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s00167-015-3715-4","article-title":"The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle\u2010trochlear groove (TT\u2010TG) and tibial tubercle\u2010posterior cruciate ligament (TT\u2010PCL) distances","volume":"25","author":"Heidenreich MJ","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1186\/s13018-021-02527-x","article-title":"Accuracy of 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