{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:53:18Z","timestamp":1792021998399,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,8,18]],"date-time":"2020-08-18T00:00:00Z","timestamp":1597708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,8,18]],"date-time":"2020-08-18T00:00:00Z","timestamp":1597708800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,8,18]],"date-time":"2020-08-18T00:00:00Z","timestamp":1597708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20\u2010mm\u2010depth drilling was simulated, starting from the insertion point at every possible angle within a 90\u00b0 cone using 5\u2010, 6\u2010 and 7\u2010mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student\u2019s <jats:italic>t<\/jats:italic> test and one\u2010way ANOVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Maximum physeal damage (5.35% [4.47\u20136.24]) was obtained with the 7\u2010mm drill when drilling 3\u00b0 cephalic and 15\u00b0 posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07\u20130.37]) was obtained using the 5\u2010mm drill aimed 45\u00b0 distal and 0\u00b0 anteroposterior, not affected by sex (n.s.). Considering intra\u2010articular drilling avoidance, the safest zone was obtained when aiming 30\u00b0\u201340\u00b0 distal and 5\u00b0\u201335\u00b0 anterior, regardless of sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30\u00b0\u201340\u00b0 distal and 5\u00b0\u201335\u00b0 anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06229-5","type":"journal-article","created":{"date-parts":[[2020,8,18]],"date-time":"2020-08-18T07:02:49Z","timestamp":1597734169000},"page":"1822-1829","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates"],"prefix":"10.1002","volume":"29","author":[{"given":"Sebasti\u00e1n","family":"Irarr\u00e1zaval","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Orthopedic Surgery Department Pontificia Universidad Cat\u00f3lica de Chile Diagonal Paraguay N\u00ba 362, 3rd floor Santiago 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