{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:54:23Z","timestamp":1787313263608,"version":"build-2736575974"},"reference-count":54,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"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":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to identify the causes of failure of previous medial patellofemoral ligament reconstruction (MPFL\u2010R), and to furthermore report the surgical techniques available for MPFL revision surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four databases [PubMed, Ovid (MEDLINE), Cochrane Database, and EMBASE] were searched until September 29, 2020 for human studies pertaining to revision MPFL. Two reviewers screened the literature independently and in duplicate. Methodological quality of the included studies was assessed using the Methodological Index for Non\u2010Randomized Studies (MINORS) criteria, or the CAse REport guidelines (CARE), where appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen studies (one level II, one level III, two level IV, ten level V) were identified. This search resulted in a total of 76 patients with a mean age (range) of 22 (14\u201339) years. The patients were 75% female with a mean (range) time to revision of 24.1 (1\u201360) months and mean (range) follow\u2010up of 36.2 (2\u201348) months. The most common indication for revision surgery was malpositioning of the femoral tunnel (38.1%), unaddressed trochlear dysplasia (18.4%), patellar fracture (11.8%). Femoral tunnel malposition was typically treated via revision MPFL\u2010R with quadriceps tendon or semitendinosus autograft and may retain the primary graft if fixation points were altered. Unaddressed trochlear dysplasia was treated with deepening trochleoplasty with or without revision MPFL\u2010R, and patella fracture according to the nature of the fracture pattern and bone quality. Though generally, outcomes in the revision scenario across all indications were inferior to those post\u2010primary procedure, overall, revision patients demonstrated positive improvements in pain and instability symptoms. Transverse patella fractures treated with debridement and filling with demineralized bone matrix if required with further fixation according to the fracture pattern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The most common causes of MPFL failure in literature published to date, in order of decreasing frequency, are: malposition of the femoral tunnel, unaddressed trochlear dysplasia, and patellar fracture. Although surgical techniques of revision MPFL\u2010R to manage these failures were varied, promising outcomes have been reported to date. Larger prospective comparative studies would be useful to clarify optimal surgical management of MPFL\u2010R failure at long\u2010term follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-021-06603-x","type":"journal-article","created":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:03:54Z","timestamp":1620432234000},"page":"1352-1361","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Femoral tunnel malposition is the most common indication for revision medial patellofemoral ligament reconstruction with promising early outcomes following revision reconstruction: a systematic review"],"prefix":"10.1002","volume":"30","author":[{"given":"Madison","family":"Walker","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Michael G. 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DeGroote School of Medicine McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Kay","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Division of Orthopaedic Surgery, Department of Surgery McMaster University Medical Centre 1200 Main St West 4E14 L8N 3Z5 Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Faculty of Health Sciences McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Almasri","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Division of Orthopaedic Surgery, Department of Surgery McMaster University Medical Centre 1200 Main St West 4E14 L8N 3Z5 Hamilton ON Canada"},{"name":"<!--<label>4<\/label>--> Mercy Health\u2014Cincinnati SportsMedicine and Orthopaedic Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Darren de SA","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Division of Orthopaedic Surgery, Department of Surgery McMaster University Medical Centre 1200 Main St West 4E14 L8N 3Z5 Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,8]]},"reference":[{"key":"e_1_2_10_2_2","unstructured":"deAbreu\u2010E\u2010SilvaGM BuarqueFA DiasTS LeiP BuenoEL deAndradeMAAnatomical femoral tunnel positioning in the medial patellofemoral ligament reconstruction: is the free\u2010hand technique accurate?.Ann Transl 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