{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:44:15Z","timestamp":1792082655177,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate whether a lower preoperative patella\u2013patellar tendon angle (P\u2010PTA) is associated with progression of patellofemoral osteoarthritis (PFOA) in patients undergoing anterior cruciate ligament (ACL) revision surgery. We hypothesised that patients with lower preoperative P\u2010PTA would have higher odds of PFOA progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A database search (2015\u20132023) included patients who underwent ACL revision surgery with magnetic resonance imaging (MRI) available at both initial and revision ACL injuries. Inclusion criteria were primary arthroscopic anterior cruciate ligament reconstruction without cartilage restoration procedures and \u22652 years between ACL injuries. Demographic data, graft type, patellofemoral joint measurements (P\u2010PTA, Sagittal tibial tubercle\u2010trochlear groove distance, Insall\u2013Salvati ratio) and PFOA progression were collected at both time points. PFOA progression was defined using MRI osteoarthritis knee score (MOAKS) criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010two knees in 61 patients met the inclusion criteria (mean age at primary injury 30.60\u2009\u00b1\u200912.30 years; body mass index 26.70\u2009\u00b1\u20094.40\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; mean interval between injuries 4.77\u2009\u00b1\u20093.04 years). Twenty\u2010two knees (35.50%) had no PFOA progression, and 40 (64.50%) had progression. Preoperative P\u2010PTA was significantly lower in the progression group (141.90\u2009\u00b1\u20094.60\u00b0) than in the no\u2010progression group (144.80\u2009\u00b1\u20095.70\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044); this difference persisted at the second injury (142.30\u2009\u00b1\u20094.90\u00b0 vs. 145.60\u2009\u00b1\u20096.60\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). Age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and graft type (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) also differed between groups. Insall\u2013Salvati and sTT\u2010TG at the first injury did not differ between groups. Multivariable logistic regression identified lower preoperative P\u2010PTA as an independent predictor of progression (OR: 1.15 per 1\u00b0 decrease; 95% CI: 1.02\u20131.30;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022). P\u2010PTA alone showed limited discrimination (AUC: 0.66, 95% CI: 0.50\u20130.80), whereas the multivariable model showed higher apparent discrimination (AUC: 0.79, 95% CI: 0.68\u20130.90). Both receiver operating characteristic analyses were derived and evaluated in the same cohort, and no independent validation was performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this ACL revision cohort, a lower preoperative P\u2010PTA was independently associated with MOAKS\u2010defined PFOA progression. Each 1\u00b0 decrease in P\u2010PTA was associated with 15% higher odds of progression. However, the mean between\u2010group difference was smaller than the MDC95, limiting individual\u2010level interpretation of P\u2010PTA measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70931","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:44:52Z","timestamp":1791211492000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lower patella\u2013patellar tendon angle is associated with increased odds of patellofemoral osteoarthritis progression in ACL revision patients: A case control study"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3566-5778","authenticated-orcid":false,"given":"Domenico","family":"Franco","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Harvard Medical School, Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chilan B. G.","family":"Leite","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Harvard Medical School, Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Krabb","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Harvard Medical School, Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim University of Heidelberg Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Medina","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Harvard Medical School, Brigham and Women's Hospital Boston Massachusetts USA"},{"name":"Department of Orthopaedic Surgery Harvard Medical School, Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Berkson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Harvard Medical School, Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D.","family":"Asnis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Harvard Medical School, Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars C.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Harvard Medical School, Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth 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