No Difference in Tibial Tubercle Trochlear Groove Distance Between Patients With and Without a History of Anterior Cruciate Ligament Tears

Sep 29, 2026

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This cross-sectional study evaluates whether tibial tubercle–trochlear groove (TT-TG) distance differs between patients with ACL injury history and those without ACL injury. Patients aged 18–50 with noncontact ACL tears (2020–2021) were compared with a matched cohort with meniscal tears, excluding those without preoperative MRI. After measuring TT-TG on axial MRI images, 159 ACL-injured and 140 ACL-intact patients showed no significant TT-TG difference (P=.246). Results do not support TT-TG distance as an ACL deficiency association.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Background

Hypothesis

Study Design and Methods

Participants and Exclusions

Measurements and Statistics

Results

Conclusion

Original Research No Difference in Tibial Tubercle Trochlear Groove Distance Between Patients With and Without a History of Anterior Cruciate Ligament Tears Nathaniel M. Tchangou,* y BS, Rahul R. Muchintala,* MD, Adeeb J. Hanna,* MD, Ryan W. Paul,* BS, Ari J. Clements,* MD, John Dinger,* BS, John Czarnecki,* BS, Ralph Cook,* MD, Neel K. Patel,* MD, Michael G. Ciccotti,* MD, Steven B. Cohen,* MD, Meghan E. Bishop,* MD, and Brandon J. Erickson, z MD Investigation performed at Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA | Background: The tibial tubercle–trochlear groove (TT-TG) distance is a known risk factor for patellar instability, but its role in anterior cruciate ligament (ACL) deficiency is unclear. Previous studies found an increased TT-TG distance in patients with noncontact ACL tears compared with patients with intact ACLs.
Hypothesis: The authors hypothesize that there will be a significantly increased TT-TG distance in patients with ACL injury compared with patients without ACL injury.
Study Design: Cross-sectional study; Level of evidence, 3 .
Methods: All patients aged 18 to 50 years who had noncontact ACL tears between 2020 and 2021 were included in this study. Patients with ACL tears were compared with a similar cohort of patients with meniscal tears, matched for age and sex, between 2020 and 2021 . Patients were excluded if preoperative magnetic resonance imaging (MRI) was unavailable. One author reviewed axial images to measure TT-TG distance. An independent 1-tailed t test was used to assess for a difference in TT-TG distance between patients with and without ACL injury.
Results: The TT-TG distance was measured for 299 patients, of whom 159 had an ACL injury and 140 patients had intact ACLs. Patients with an ACL injury had a mean TT-TG distance of 11.3 6 4.10 mm, and patients without ACL injury had a mean TT-TG distance of 11.9 6 4.62 mm. There was no significant difference in TT-TG distance between the 2 groups (P = .246) . The sample of patients in both groups had no significant differences in age, sex, or laterality of injury.
Conclusion: No statistically significant difference in TT-TG distance was found between patients with and without ACL injury. The findings of this study do not support an association between TT-TG distance and ACL deficiency. Instead, TT-TG distance may vary as a result of ACL injury due to increased laxity in tibial external rotation.
Keywords: TT-TG distance; ACL reconstruction; knee; risk factor | | | --- | --- | | Anterior cruciate ligament (ACL) tears are one of the most common injuries seen by orthopaedic surgeons, especially | factors for ACL injury and strategies to improve outcomes after ACL reconstruction surgery. 1,2 Previously identified | | in young, active patients who take part in recreational | risk factors for ACL injury include female sex, younger | | and competitive sports.8 The ACL has an integral role in | age, hyperlaxity, participation in soccer, history of contra- | | providing rotational stability and preventing excessive | lateral ACL injury, and knee valgus.7,8,12,14 However, more | | anterior translation of the tibia in any activity.15 Given | risk factors are being investigated to better understand | | its prevalence, research has focused on determining risk | modifiable risk factors for ACL injury or graft failure after reconstruction surgery. More research analyzing risk factors and concomitant procedures performed during ACL | | The Orthopaedic Journal of Sports Medicine, 14(1), 23259671251403157 | reconstruction or revision will ultimately help prevent | | DOI: 10.1177/23259671251403157
􀀂 The Author(s) 2026 | graft failure and provide better care. | This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by-nc-nd/4.0/](lice

FAQs

What was the study trying to determine about TT-TG distance and ACL injury?

The study tested whether TT-TG distance is significantly increased in patients with ACL injury compared with patients without ACL injury history.

How were participants selected and what comparisons were made?

Patients aged 18 to 50 with noncontact ACL tears between 2020 and 2021 were compared with a similar cohort with meniscal tears, matched for age and sex, from 2020 to 2021. Preoperative MRI availability was required.

What did the results show about TT-TG distance between the two groups?

TT-TG distance was not significantly different between groups (mean 11.3 ± 4.10 mm vs 11.9 ± 4.62 mm; P = .246), and the findings did not support an association with ACL deficiency.

Sep 29, 2026

Upload by Eliana