{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:02:59Z","timestamp":1789614179521,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To quantify the amount of error in commonly used radiographic measurements of patella alta with progressive malposition of the knee.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Three\u2010dimensional models were derived from computed tomography scans of patients with unilateral patellar instability. Models with knee flexion angles between 20\u00b0 and 30\u00b0 were projected onto 2\u2010dimensional radiographs to create a perfect lateral radiograph. Progressive internal\/external rotation and ad\/abduction of the knee were performed to simulate malpositioning of the knee. For each 5\u00b0 increment of aberrant positioning, corresponding measurements of posterior and distal condylar overlap were measured, and measurements of patella alta were compared, including Insall\u2010Salvati (IS), modified IS, Blackburne\u2010Peel Index, Caton\u2010Deschamps Index, and patellotrochlear index, with a 0.05 change considered to be clinically significant.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 40 knees from 20 patients were included in this study. On radiographic views, for every 5\u00b0 of aberrant rotation or ab\/adduction, the overlap between the posterior condyles increased by approximately 4\u2009mm (\n P<\/jats:italic>\n \u2009<\u2009.001). IS measurements were the least sensitive to aberrant motion (range \u22120.023 to 0.012). Caton\u2010Deschamps Index and Blackburne\u2010Peel Index showed clinically and statistically relevant deviations at larger degrees of external rotation, whereas modified IS showed statistically relevant deviations in both abduction and adduction (0.054 at 10\u00b0).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Malposition of the knee on 2\u2010dimensional radiographs produced clinically relevant errors in the measurements of patellar height that varied by the method of measurement. The extent of condylar overlap can be used as a surrogate to estimate the extent of malpositioning and the potential for error in the measurement of patella alta on radiographic images.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, case\u2010control study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70543","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:55:01Z","timestamp":1789613701000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knee Malposition During Radiographs Can Produce Clinically Relevant Errors in Measurements of Patellar Height"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-9273","authenticated-orcid":false,"given":"Mark","family":"Cote","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4486-7057","authenticated-orcid":false,"given":"Chance","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4864-9840","authenticated-orcid":false,"given":"Patrick","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6457-9248","authenticated-orcid":false,"given":"Maria V.","family":"Velasquez\u2010Hammerle","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2779-7534","authenticated-orcid":false,"given":"F. Joseph","family":"Simeone","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8032-6681","authenticated-orcid":false,"given":"Fang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6489-3803","authenticated-orcid":false,"given":"Miho J.","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.csm.2021.07.002","article-title":"Patella alta: When to correct and impact on other anatomic risk factors for patellofemoral instability","volume":"41","author":"Biedert RM","year":"2022","journal-title":"Clin Sports Med."},{"key":"e_1_2_7_3_1","first-page":"290","article-title":"Patella alta: A comprehensive review of current knowledge","volume":"46","author":"Biedert RM","year":"2017","journal-title":"Am J Orthop."},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"3099","DOI":"10.1007\/s00167-016-4117-y","article-title":"An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations","volume":"25","author":"Arendt EA","year":"2017","journal-title":"Knee Surg Sports Traumatol 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tubercle\u2010trochlear groove distance and patella alta","volume":"34","author":"Redler LH","year":"2018","journal-title":"Arthroscopy."},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"e523","DOI":"10.1016\/j.asmr.2023.02.006","article-title":"Preoperative patella alta on Caton\u2010Deschamps index is a predictor of outcome following isolated medial patellofemoral ligament reconstruction","volume":"5","author":"Brutico J","year":"2023","journal-title":"Arthrosc Sports Med Rehabil."},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"e609","DOI":"10.1016\/j.eats.2022.12.015","article-title":"Tibial tubercle osteotomy with distalization for the treatment of patella alta","volume":"12","author":"Palhares G","year":"2023","journal-title":"Arthrosc Tech."},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/JSA.0000000000000151","article-title":"Complications of tibial tuberosity osteotomy","volume":"25","author":"Johnson 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