European Radiology

, Volume 28, Issue 11, pp 4669–4680 | Cite as

Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative

  • Arya Haj-MirzaianEmail author
  • Ali Guermazi
  • Michael Hakky
  • Christopher Sereni
  • Bashir Zikria
  • Frank W. Roemer
  • Miho J. Tanaka
  • Andrew J. Cosgarea
  • Shadpour Demehri



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.

Key Points

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).


Osteoarthritis Knee Patella Magnetic resonance imaging 





Anterior cruciate ligament


Analysis of variance


Area under the curve


Body mass index


Bone marrow lesion


Confidence interval


Computed tomography


Dual echo at steady state


Foundation for the National Institute of Health


Intermediate weighted


Joint space loss




Magnetic resonance imaging osteoarthritis knee score


Multiplanar reconstruction


Magnetic resonance imaging




Osteoarthritis initiative


Odds ratio


Physical activity scale for elderly


Receiver-operating characteristic


Standard deviation


Turbo spin echo


Tibial tuberosity medialization (TTM)


Tibial tuberosity trochlear groove


Water excitation


Western Ontario & McMaster Universities osteoarthritis index



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Shadpour Demehri.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because we used the open access OAI database. All enrolled subjects in OAI study gave informed consent.

Ethical approval

Institutional Review Board approval was not required because we used the open access OAI database.

The OAI study has received ethics board approval by the institutional review board at the University of California, San Francisco (OAI Coordinating Center; Approval Number: 10-00532).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the OAI database and OAI-related articles.


• prospective

• observational

• multicenter study

Supplementary material

330_2018_5460_MOESM1_ESM.docx (109 kb)
ESM 1 (DOCX 109 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Arya Haj-Mirzaian
    • 1
    Email author
  • Ali Guermazi
    • 2
  • Michael Hakky
    • 3
  • Christopher Sereni
    • 4
  • Bashir Zikria
    • 5
  • Frank W. Roemer
    • 2
    • 6
  • Miho J. Tanaka
    • 5
  • Andrew J. Cosgarea
    • 5
  • Shadpour Demehri
    • 1
  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of RadiologyBoston University School of MedicineBostonUSA
  3. 3.Department of RadiologyFlorida HospitalMaitlandUSA
  4. 4.Department of RadiologyUniversity of Massachusetts Medical SchoolBostonUSA
  5. 5.Department of Orthopaedic SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of RadiologyUniversity of Erlangen-NurembergErlangenGermany

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