{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T16:40:34Z","timestamp":1793724034316,"version":"4.6.1"},"reference-count":22,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patellar instability is a common knee pathology in skeletally immature patients. In skeletally mature populations, a tibial tubercle\u2013trochlear groove (TT-TG) distance of \u226520 mm is generally considered a pathological value. However, as pediatric patients grow and as the TT-TG distance varies with age, applying the same cutoff value as adult patients to them is unreasonable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>This study aimed to analyze the normative values of the TT-TG and tibial tubercle\u2013posterior cruciate ligament (TT-PCL) distances in children with no patellofemoral instability and to propose the cutoff value of the TT-TG and TT-PCL distances predictive of increased risk of patellofemoral instability in pediatric patients. We hypothesized that the TT-TG and TT-PCL distances increase with age in children and adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Magnetic resonance imaging scans of the knee were collected from the patellar instability group and the control group. The TT-TG and TT-PCL distances were measured. The normalized values of the TT-TG and TT-PCL distances were calculated by dividing them by the femoral width. Segmented analysis with 1 breakpoint was performed for both the TT-TG and the TT-PCL distances. The optimal cutoff values of the TT-TG and TT-PCL distances were calculated by maximizing the sum of the sensitivity and specificity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 87 patients had patellar instability, and 509 patients did not. The median values of TT-TG and TT-PCL distances in the control group (8.18 mm and 19.48 mm, respectively) were significantly smaller than those in the instability group (16.10 mm and 24.41 mm, respectively). For those aged &lt;15 years, the TT-TG distance significantly increased by 0.39 mm as the age increased by 1 year. The TT-PCL distance increased by 1.14 mm\/year until the age of 11 years. In our cohort, the cutoff value of the TT-TG distance of 14.90 mm yielded 66% sensitivity and 81.9% specificity for predicting an increased risk of patellar instability. The cutoff value of the TT-PCL distance of 23.68 mm yielded 63.9% sensitivity and 65.3% specificity for predicting an increased risk of patellar instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In our cohort of 596 participants, we have documented the normative values of the TT-TG and TT-PCL distances in children aged &lt;20 years. During the surgery for patellar instability in pediatric patients, orthopaedic surgeons should consider the normative values of the TT-TG and TT-PCL distances according to age to determine which patients need distal realignment surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231165521","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T07:43:25Z","timestamp":1682322205000},"page":"1785-1791","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["Normative Values of Tibial Tubercle\u2013Trochlear Groove Distance and Tibial Tubercle\u2013Posterior Cruciate Ligament Distance in Children"],"prefix":"10.1177","volume":"51","author":[{"given":"Se Jin","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hyun","family":"Won","sequence":"additional","affiliation":[{"name":"Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Hyuk","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,4,24]]},"reference":[{"key":"bibr1-03635465231165521","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511404883"},{"key":"bibr2-03635465231165521","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-018-9481-4"},{"issue":"11","key":"bibr3-03635465231165521","first-page":"2026","volume":"33","author":"Brady 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