International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 08 Issue 09, May, 2016

Pages: 45-47

Date of Publication: 12-May-2017


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MORPHOLOGICAL STUDY OF THE TIBIAL TUBEROSITY IN THE POPULATION OF SOUTH KARNATAKA, INDIA

Author: Rashmi Bhat, Ramya Rathan, Neha Samapriya, Shakuntala Pai

Category: Healthcare

Abstract:Objective: To estimate the prevalence of various morphological types of Tibial Tuberosity and to determine the side and gender differences.
Methods: 170 randomly collected tibiae of unknown sex were analysed to evaluate the shapes and the gender differences in the tibia. The prominence of the Tibial Tuberosity and the gender differences of the bone was determined
Results: Type 2 TT was the most common type seen in 34% bones followed by type 3 in 17% of the bones. Type 2 TT was the most common type seen on right side (31%) as well as on the left side (39%). Type 2 was the most common type of TT seen in both males (32%) and females (35%).
Conclusion: The present study shows variations in shape may be due to developmental reasons. There were no statistical differences in the side and gender differences. The knowledge of the present study will help further researchers in evaluating anterior knee pain syndromes.

Keywords: Tibia, Tibial Tuberosity, Shape, Gender

Full Text:

INTRODUCTION
The Tibial tuberosity(TT) is a bony landmark present at the proximal end of the tibia. It is one of the bony points to measure the Quadriceps angle (Q angle) for assessing patellofemoral mechanics. The TT is an apophysis and develops in traction.1 Development of the tubercle has been divided into four stages: cartilaginous, apophyseal, epiphyseal, and bony.2 The TT begins ossification at between seven and nine years as a distal focus. This progressively enlarges proximally and anteriorly, while the proximal tibial epiphysis concomitantly expands downward into the tuberosity.3 The TT projects only a little and is divided into distal rough and a proximal smooth region. The patellar tendon is attached to the proximal smooth area while the distal end is palpable.4 The morphology of the TT has received scant attention by researchers. Variations in the morphology of the TT could cause errors in determining its precise location. The shape and the position of the TT influences the value of the Q angle and also has impact on patellofemoral biomechanics. According to Van Eijdn et al(1987)5 ,a TT which is anteriorly placed increases the length of the contact paths on both patellar and femoral articulating surfaces, produces a lengthening of the moment arm of the patellar ligament force which may either decrease or increase the ratio between patellar ligament force and quadriceps muscle force.5 An abnormal lateral position of the TT causes distal malalignment of the extensor mechanism of the knee and can lead to lateral tracking of the patella which causes anterior knee pain or objective patellar instability and is mainly characterised by recurrent dislocation.( Koetar S et al, 2007)6. The methods used to determine the position of the TT include clinical assessment7 , conventional radiography using marking wires8 and CT scan.6,7,8,9,10 Of these methods, measurements done on CT scans appear to be the most reliable.6 However, a survey of the literature did not reveal any study that used direct bony measurements. This information is likely to be useful to the clinician in evaluating anterior knee pain syndromes. With reference to the above literature the main objective of the current study is to estimate the prevalence of various morphological types of TT and to determine the side and gender differences.

MATERIALS AND METHODS
The material for the present study comprised of one hundred and seventy adult human tibia bones. The tibias were collected from the department of Anatomy from various Medical colleges in the Southern region of Karnataka. 170 tibiae were studied of which 101 belonged to right side and 69 to left side. The bones were first selected by using inclusion criteria and were numbered. The Prominence of the TT was assessed by analysing the end on frontal view photos with Adobe Photoshop version 5.0 (vide infra).

SUBJECTIVE SEXING OF THE TIBIA: was done to determine the gender differences in the above measurements. The criteria used were

• Weight and the length: measured by Electronic balance and Osteometric Board

• Mid-shaft circumference: First, the midpoint of the total length of tibia was marked. Then the midshaft circumference was measured using measuring tape.

• Width at the proximal and distal end: Were measured using digital callipers at the widest region.

• Minimum girth of the shaft: measured at the junction of middle and lower third using measuring tape.

• The bones were then classified as males or females using the demarking points given by Singh and Singh et al.11

RESULTS
The TT was classified into 5 types based on the shape of the ridge separating the proximal and distal parts of TT. The prevalence of the 5 types of TT is shown in table 1. Type 2 TT was the most common type seen in 34% bones followed by type 3 in 17% of the bones. Type 5 TT was the least common type. Table 2 shows that Type 2 TT was the most common type seen on right side (31%) as well as on the left side (39%). Type 1 was seen to be more common on right side than on left and type 3 was more common on the left side than on the right, however both were not statistically significant. Type 5 TT was the least common type. Type 2 was the most common type of TT seen in both males (32%) and females (35%) and is present in table 3. It’s of interest to note that a ridge on TT was always present in male tibiae when compared to female tibiae which was statistically significant.

DISCUSSION
In review of literature it was noticed that there are no documented works on classification of TT based on shape of the ridge separating the proximal and distal parts of TT. Hence, comparison with other studies could not be done. This ridge across the TT marks the distal limit of the proximal tibial growth plate.3 In the present study it was noticed that the oblique shape of the ridge was most common (34%) while absence of ridge on TT was the least common (6%). This suggests that the shape of the ridge is influenced by the proximal epiphyseal pull. When analysed for side differences it was observed that that there was no significant difference between the right and left in the prevalence of morphological types of TT. If paired right and left tibia of the same cadaver were available this difference could have been analysed better. Gender difference in the morphological types of TT was further analysed. For this purpose the subjective classification of the tibia according to various parameters was done. It was noted that there was no significant difference. Of interest here to note is the constant presence of the ridge on the TT in male tibiae where as about 10% of female tibiae lacked this ridge suggesting the differential amount of force applied to this proximal epiphyseal plate in males and females. The difference was statistically significant.

CONCLUSION
The present study shows variations in shape may be due to developmental reasons. There was no statistical differences in the side and gender. The present study will help further researchers in evaluating anterior knee pain syndromes.

AKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of funding: NIL Conflict of Interest: NIL.


References:

1. Ogden JA, Southwick WO. Osgood–Schlatter’s disease and tibial tuberosity development. Clin Orthop Relat Res 1976; 116:180–189.

2. Ehrenborg G, Engfeldt B. The insertion of the ligamentum patellae on the tibial tuberosity. Some views in connection with the Osgood–Schlatter lesion. Acta Chir Scand 1961; 121:491–499.

3. Ogden JA. Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol 1984; 11(4): 246-57.

4. Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC et al, editors. Gray’s anatomy: The Anatomical basis of clinical practice. 40th ed. UK, Elsevier Ltd; 2008. p. 1412-15.

5. Van Eijden TMGJ, Kouwenhoven E and Weijs WA. The influence of anterior displacement of the TT on patellofemoral biomechanics. International Orthopaedics.1987; 11(3): 215-221.

6. Koetar S, Diks MJ, Anderson PG, Wymenga AB. A modified tibial tubercle osteotomy for patellar maltracking: result at two years. J Bone Joint Surg Br. 2007 Feb; 89(2): 180-5.

7. Shakespeare D, Fick D. Patellar instability- canthe TT-TG distance be measured clinically? Knee. 2005 Jun; 12(3): 201-4.

8. Nagamine R, Miura H, Urabe K, Matsuda S, Chen WJ, Matsunobu T. Radiological assessment of the position of the tibial tuberosity by means of a marking in knees with patellofemoral arthritis. Skeletal radiol. 1999 Jan; 28(1): 27-32.

9. P. Schoettle, M. Zanetti, B. Seifert, C. Pfirrmann, S. Fucentese, J. Romero. The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. The Knee.2006 ;13(1): 26-31.

10. Jones RB, Barlett EC, Vainright JR, Carroll RG. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain. Skeletal Radiol. 1995 Oct; 24(7): 505-9.

11. Singh G, Singh S, Singh SP. Identification of sex from tibia. J Anat Soc India 1975;24(1).

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A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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