The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

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The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear.


To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls.

Study Design:

Cross-sectional study; Level of evidence, 3.


A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans.


The cohort with PFP demonstrated a significantly greater mean TT-TG distance relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = .001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥20 mm.


Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee.

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