{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:59:25Z","timestamp":1790740765769,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"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":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Determine whether patellar height differs significantly between knees with objective patellar instability (OPI) and controls, and to develop a magnetic resonance imaging\u2010based (MRI\u2010based) quantitative method for classifying \u2018functional patella alta\u2019 relative to both tibia and trochlea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross\u2010sectional study included all records of adults who underwent an MRI of their knee between 2019 and 2022 at the senior authors' centre. The OPI group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009127) included patients with &gt;2 documented episodes of lateral patellar dislocation and no previous knee surgery, and the control group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200997) included patients with isolated meniscal tears and no history of patellofemoral disorders or knee surgery. Four readers independently measured the MRI patellar height index (PHI), the sagittal patellar engagement (SPE) index and the patellar tendon length (PTL). The control group's interquartile ranges of PHI (75th percentile) and SPE index (25th percentile) were used to define \u2018patella norma\u2019 (PHI\u2009\u2264\u20091.16 and SPE index\u2009\u2265\u20090.38) and \u2018functional patella alta\u2019 (PHI\u2009&gt;\u20091.16 and SPE index\u2009&lt;\u20090.38). Multivariable logistic regression analyses assessed the associations between patellar height and trochlear dysplasia with knees exhibiting OPI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Comparison between \u2018patella norma\u2019 and \u2018functional patella alta\u2019 revealed statistically significant differences for PHI (mean difference [MD], \u22120.23;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), SPE index (MD, 0.28;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and PTL (MD, \u22127;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The prevalence of \u2018functional patella alta\u2019 was 24% in OPI knees (30 of 127) and 6% in control knees (6 of 97). Multivariable logistic regression revealed that \u2018functional patella alta\u2019 and trochlear dysplasia were independently associated with OPI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standardized MRI\u2010based assessment of patella alta relative to both tibia and trochlea is reliable using thresholds of PHI (&gt;1.16) and SPE index (&lt;0.38). These thresholds, specifically developed for MRI, should improve the conventional assessment using the Caton\u2013Deschamps index, originally developed for true lateral radiographs.<\/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\/ksa.12757","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T08:23:49Z","timestamp":1753086229000},"page":"1584-1596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Standardized magnetic resonance image\u2010based assessment to define functional patella alta relative to both tibia and trochlea: A cross\u2010sectional comparative study"],"prefix":"10.1002","volume":"34","author":[{"given":"David H.","family":"Dejour","sequence":"first","affiliation":[{"name":"Lyon\u2010Ortho\u2010Clinic, Clinique de la Sauvegarde, Ramsay Sant\u00e9 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Pasqualotto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Puglia","sequence":"additional","affiliation":[{"name":"UOC Prima Clinica Ortopedica, ASST Gaetano Pini\u2010CTO Milano Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Amarossi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0855-3852","authenticated-orcid":false,"given":"Jacobus H.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"ReSurg SA Nyon Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo Giovanetti","family":"de Sanctis","sequence":"additional","affiliation":[{"name":"Lyon\u2010Ortho\u2010Clinic, Clinique de la Sauvegarde, Ramsay Sant\u00e9 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Patellofemoral Imaging Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Ferrua","sequence":"additional","affiliation":[{"name":"UOC Prima Clinica Ortopedica, ASST Gaetano Pini\u2010CTO Milano Milano Italy"},{"name":"Department of Biomedic Sciences for Health Universit\u00e0 degli Studi di Milano Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.2729"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4117-y"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-005-0015-4"},{"issue":"6","key":"e_1_2_12_5_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_12_6_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.59B2.873986"},{"issue":"5","key":"e_1_2_12_7_1","first-page":"317","article-title":"[Patella infera. Apropos of 128 cases]","volume":"68","author":"Caton J","year":"1982","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07255-1"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00268170"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2013.10.008"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","unstructured":"DejourDH deSanctisEG M\u00fcllerJH DerocheE PinedaT GuarinoA et al.Adapting the Dejour classification of trochlear dysplasia from qualitative radiograph\u2010 and CT\u2010based assessments to quantitative MRI\u2010based measurements.Knee Surg Sports Traumatol Arthrosc.2024.https:\/\/doi.org\/10.1002\/ksa.12539","DOI":"10.1002\/ksa.12539"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-021-00430-2"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"e_1_2_12_15_1","unstructured":"GamerM LemonJ. Package \u2018irr\u2019 version 0.84.1. 2022. Available from:https:\/\/www.r-project.org"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2023.04.005"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199209000-00022"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12210"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1148\/101.1.101"},{"key":"e_1_2_12_20_1","unstructured":"KassambaraA. ggpubr: \u201cggplot2\u201d based publication ready plots (Version 0.1.7). 2018. Available from:https:\/\/CRAN.R-project.org\/package=ggpubr. Accessed 4 Apr 2024."},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07635-1"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-06953-0"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-015-2268-9"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-021-03937-y"},{"key":"e_1_2_12_25_1","unstructured":"SchaubergerP WalkerA BragliaL. Openxlsx: read write and edit xlsx files. R package version. 4(5). 2020."},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231158099"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v021.i12"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1599249"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12757","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ksa.12757","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12757","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:22:38Z","timestamp":1777371758000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ksa.12757"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12757","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]},"assertion":[{"value":"2025-03-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}