{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:58:21Z","timestamp":1790395101508,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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 evaluate the association between the preoperative sagittal tibial tubercle\u2010trochlear groove (sTTTG) distance and postoperative patient\u2010reported outcomes after combined patellofemoral ligament reconstruction and deepening trochleoplasty in patients with recurrent lateral patellar instability and high\u2010grade trochlear dysplasia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective study included patients who underwent combined medial patellofemoral ligament reconstruction and deepening trochleoplasty for recurrent lateral patellar instability with high\u2010grade trochlear dysplasia (Dejour grade B\u2010D) between 2016 and 2018. Eligibility required \u22652 documented patellar dislocations or persistent symptoms after \u22656\u2009months of nonoperative treatment, high\u2010grade trochlear dysplasia on magnetic resonance imaging, and a minimum follow\u2010up of 18\u2009months. The sTTTG distance was measured on preoperative axial T2\u2010weighted magnetic resonance imaging sequences as the perpendicular offset between the trochlear cartilage and the tibial tubercle, referenced to the posterior condylar axis. Postoperative outcomes were assessed using the Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) score, alongside numeric rating scales for pain levels and subjective knee function. Univariable and multivariable linear regression analyses were performed, adjusting for age, body mass index, Caton\u2010Deschamps index, Dejour classification of trochlear dysplasia, and tibial tubercle\u2010trochlear groove distance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 101 patients (29 men, 72 women; mean age 22.7\u2009\u00b1\u20096.6\u2009years; body mass index 24.3\u2009\u00b1\u20094.9) were included with a mean follow\u2010up of 32.3\u2009\u00b1\u20098.7\u2009months (range 19\u201060). Univariable analysis showed that a higher preoperative sTTTG was significantly associated with improved postoperative subjective function (\n \u03b2<\/jats:italic>\n \u2009=\u20090.088,\n P<\/jats:italic>\n \u2009=\u2009.014), lower pain levels (\n \u03b2<\/jats:italic>\n \u2009=\u2009\u22120.10,\n P<\/jats:italic>\n \u2009=\u2009.048), and higher BPII 2.0 scores (\n \u03b2<\/jats:italic>\n \u2009=\u20090.98,\n P<\/jats:italic>\n \u2009=\u2009.019). These associations remained statistically significant after adjusting for confounding variables (function:\n \u03b2<\/jats:italic>\n \u2009=\u20090.096,\n P<\/jats:italic>\n \u2009=\u2009.011; pain:\n \u03b2<\/jats:italic>\n = \u22120.11,\n P<\/jats:italic>\n \u2009=\u2009.044; BPII 2.0:\n \u03b2<\/jats:italic>\n \u2009=\u20090.91,\n P<\/jats:italic>\n \u2009=\u2009.037). Based on a cohort\u2010specific minimal clinically important difference analysis, 89% of patients achieved clinically meaningful improvement in BPII 2.0, 77% in pain, and 88% in function. The multivariable models exhibited moderate explanatory power, with adjusted\n R<\/jats:italic>\n 2<\/jats:sup>\n values ranging from 0.03 to 0.06.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The preoperative sTTTG distance is significantly associated with postoperative patient\u2010reported outcomes in individuals undergoing deepening trochleoplasty. Higher sTTTG values were associated with better functional recovery, reduced pain, and enhanced patellofemoral quality of life.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level IV, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70552","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:58:36Z","timestamp":1790391516000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Sagittal Tibial Tubercle\u2010Trochlear Groove Distance Predicts Postoperative Outcome in Patients Undergoing Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9113-480X","authenticated-orcid":false,"given":"Sebastian","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery University Medical Centre Mannheim, Medical Faculty Mannheim University of Heidelberg Mannheim Germany"},{"name":"Department of Orthopedic Surgery Brigham and Women's Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-9593","authenticated-orcid":false,"given":"Luis","family":"Navas","sequence":"additional","affiliation":[{"name":"Arcus Sportklinik Pforzheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Arcus Sportklinik Pforzheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abd El Nasser","family":"Oudeh","sequence":"additional","affiliation":[{"name":"Arcus Sportklinik Pforzheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Lattermann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Brigham and Women's Hospital Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9934-1766","authenticated-orcid":false,"given":"Peter","family":"Balcarek","sequence":"additional","affiliation":[{"name":"Arcus Sportklinik Pforzheim Germany"},{"name":"Department of Trauma Hand and Reconstructive Surgery Saarland University Medical Center Homburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/1941738117725055","article-title":"Incidence of first\u2010time lateral patellar dislocation: A 21\u2010year population\u2010based study","volume":"10","author":"Sanders TL","year":"2018","journal-title":"Sports Health."},{"key":"e_1_2_10_3_1","first-page":"1204","article-title":"High incidence of acute and recurrent patellar dislocations: A 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for high\u2010grade trochlear dysplasia: Demystifying the procedure\u2014A review of the current literature","volume":"16","author":"Tarchala M","year":"2023","journal-title":"Curr Rev Musculoskelet Med."},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/ksa.12319","article-title":"Preoperative subjective assessment of disease\u2010specific quality of life significantly influenced the likelihood of achieving the minimal clinically important difference after surgical stabilization for recurrent lateral patellar instability","volume":"33","author":"Dan Milinkovic D","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"2325967113S0004","DOI":"10.1177\/2325967113S00041","article-title":"Does 1 size fit all: Variation in tibial tubercle trochlear groove (TTTG) measurements as a function of age, size, and patellar instability","volume":"1","author":"Pennock 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Br."},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1097\/CORR.0000000000000886","article-title":"Classifications in brief: The dejour classification of trochlear dysplasia","volume":"477","author":"Kazley JM","year":"2019","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00256-024-04748-7","article-title":"A novel adapted MRI\u2010based scheme for Dejour classification of trochlear dysplasia","volume":"54","author":"Jian\u2010L\u00fcssi N","year":"2024","journal-title":"Skeletal Radiol."},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"232596712412764","DOI":"10.1177\/23259671241276446","article-title":"Ratio of tibial tubercle\u2013trochlear groove distance to patellar width as a predictor of patellar dislocation: Analysis of individualized tibial tubercle lateralization parameters","volume":"12","author":"Chen Y","year":"2024","journal-title":"Orthop 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Arthrosc."},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","first-page":"3869","DOI":"10.1007\/s00167-016-4365-x","article-title":"Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: A systematic review and meta\u2010analysis","volume":"25","author":"Balcarek P","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"3156","DOI":"10.1002\/ksa.12566","article-title":"Thin flap sulcus\u2010deepening trochleoplasty in patellar instability yields good functional outcomes without progressive cartilage deterioration in the short\u2010term follow\u2010up\u2014A retrospective single\u2010surgeon cohort study","volume":"33","author":"Frings J","year":"2025","journal-title":"Knee Surg Sports Traumatol 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