{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:02:36Z","timestamp":1791259356576,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"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 compare tibial tubercle\u2010trochlear groove (TT\u2010TG) and tibial tubercle\u2010posterior cruciate ligament (TT\u2010PCL) distances across grades of trochlear dysplasia\u00a0(TD) in patients with patellofemoral instability, to evaluate their relations with knee rotation angle (KRA) and patellar lateralization, measured as patellar tendon\u2010lateral trochlear ridge (PTLTR), and to determine its influence on surgical indications for realignment procedures.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with patellofemoral instability treated between 2017 and 2024 were retrospectively reviewed. Magnetic resonance imaging measurements included TT\u2010TG, TT\u2010PCL, TTdiff (TT\u2010TG\u2009\u2212\u2009TT\u2010PCL), KRA, and PTLTR. TD was graded by Dejour classification and grouped as normal\/low grade (normal\u2010A) or high grade (B\u2010D). Pathologic thresholds were defined as TT\u2010TG\u2009\u2265\u200915\u2009mm, TT\u2010PCL\u2009\u2265\u200924\u2009mm, and PTLTR\u2009\u2265\u20095.6\u2009mm. Independent\u2010samples t\u2010tests, Mann\u2010Whitney U tests, Pearson correlation coefficients, Fisher's exact tests, and receiver operating characteristic curve analysis were used as appropriate.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 153 patients were included. Mean TT\u2010TG and TT\u2010PCL were 17.3\u2009\u00b1\u20095.6 and 21.7\u2009\u00b1\u20094.1\u2009mm, respectively. High\u2010grade TD showed significantly greater TT\u2010TG (18.7\u2009\u00b1\u20096.3 vs 16.0\u2009\u00b1\u20095.6\u2009mm,\n P<\/jats:italic>\n \u2009=\u2009.002), KRA (4.4\u2009\u00b1\u20096.8\u00b0 vs 1.9\u2009\u00b1\u20098.0\u00b0,\n P<\/jats:italic>\n \u2009<\u2009.001), and PTLTR (18.2\u2009\u00b1\u20098.5 vs 12.6\u2009\u00b1\u20098.1\u2009mm,\n P<\/jats:italic>\n \u2009<\u2009.001), whereas TT\u2010PCL did not differ between groups (\n P<\/jats:italic>\n \u2009=\u2009.387). TT\u2010TG correlated positively with KRA (\n r<\/jats:italic>\n \u2009=\u20090.47,\n P<\/jats:italic>\n \u2009<\u2009.001), whereas TT\u2010PCL showed a weak inverse correlation (\n r<\/jats:italic>\n \u2009=\u2009\u22120.18,\n P<\/jats:italic>\n \u2009=\u2009.027); TTdiff showed the strongest association (\n r<\/jats:italic>\n \u2009=\u20090.56,\n P<\/jats:italic>\n \u2009<\u2009.001). PTLTR correlated with TT\u2010TG (\n P<\/jats:italic>\n \u2009<\u2009.001) but not TT\u2010PCL. Threshold analysis revealed discordance: 39.2% of normal\/low\u2010grade and 44.6% of high\u2010grade TD patients were pathologic by TT\u2010TG despite normal TT\u2010PCL, whereas only 26.8% met TT\u2010PCL criteria overall (\n P<\/jats:italic>\n \u2009=\u2009.004).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n TT\u2010PCL underestimates functional patellar lateralization and surgical candidacy for realignment, particularly in high\u2010grade TD where rotational malalignment is prominent. TT\u2010TG shows stronger associations with rotational alignment and patellar engagement.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70544","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T12:56:22Z","timestamp":1788699382000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tibial Tubercle\u2010Posterior Cruciate Ligament Distance Fails to Capture Pathologic Patellar Lateralization in Trochlear Dysplasia"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-5815","authenticated-orcid":false,"given":"Jakob","family":"Ackermann","sequence":"first","affiliation":[{"name":"Rush University Medical Center Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divesh","family":"Sachdev","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Amin","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9601-4217","authenticated-orcid":false,"given":"Adam B.","family":"Yanke","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s12178-022-09792-1","article-title":"Return to play considerations after patellar 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Orthop."},{"key":"e_1_2_7_40_1","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1177\/03635465251336162","article-title":"Anatomic factors influencing a persistent j\u2010sign after medial patellofemoral ligament reconstruction and distal tibial tubercle osteotomy in patients with recurrent patellar dislocations and patella alta: A retrospective cohort study","volume":"53","author":"Vial Irarrazaval R","year":"2025","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_41_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.knee.2024.12.006","article-title":"Effect of surgical treatment on relative tibial external rotation in patients with recurrent patellar dislocation","volume":"53","author":"Tang K","year":"2025","journal-title":"Knee."},{"key":"e_1_2_7_42_1","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1002\/ksa.12250","article-title":"No significant change of tibiofemoral rotation after femoral rotational osteotomy in patients with 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