{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:53:19Z","timestamp":1792021999536,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The medial patello\u2010femoral ligament (MPFL) is considered the primary restraint against patellar dislocation and its reconstruction is indicated in recurrent patellar instability. An anatomical positioning of MPFL femoral insertion is recommended to achieve satisfactory clinical outcomes and prevent osteoarthritis (OA) due to an altered kinematics. The purpose of the study was first to assess the relationship between correct femoral tunnel position and better clinical outcomes and lower patellofemoral osteoarthritis rate. Second, correlation of outcomes with factors potentially affecting the results, such as the type of graft, patellar height and trochlear dysplasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifty\u2010three patients (58\u00a0knees) who underwent MPFL reconstruction between 2009 and 2018 by a senior knee surgeon were retrospectively evaluated. Knee radiographs were performed before surgery, 12\u00a0months later and at last follow\u2010up to assess trochlear dysplasia, patellar height and patellofemoral OA. The tibial tuberosity\u2013trochlear groove (TT\u2010TG) value was measured on a CT scan. The accuracy of graft positioning was evaluated on sagittal radiographs according to Sch\u00f6ttle et al. Subjective outcomes were collected before surgery, at 12\u00a0months and at last follow\u2010up using several validated scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010six patients (51\u00a0knees) with a mean age of 24.1\u2009\u00b1\u20097.4 years were included in the study. Mean follow\u2010up was 8.9\u2009\u00b1\u20092.1 years. A significant improvement in all clinical scores was observed at 12\u00a0months and final follow\u2010up. Anatomic Insertion (AI) of reconstructed MPFL was considered optimal in 33 (64.7%) and sub\u2010optimal in 18 (35.3%) patients. Sub\u2010optimal AI resulted in lower Kujala, IKCD and higher VAS score (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01); moreover, for every 1\u00a0mm distance in any direction from the ideal insertion, a decrease of 0.8 [95% CI (\u22121.4;\u2009\u22120.2)] in Kujala score and 0.8 [95% CI (\u22121.3;\u2009\u22120.3)] in IKDC was observed. At final follow\u2010up, 8 patients presented patellofemoral OA Iwano grade 3 (15.7%): although that incidence did not correlate to graft positioning, the use the artificial ligament in all these cases appeared to be significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The present study confirms the importance of an optimal anatomic femoral insertion in MPFL reconstruction, reporting a significant positive correlation between graft positioning and clinical outcome. No significant correlations were found between anatomic insertion and patello\u2010femoral OA development.<\/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\/s00167-022-07235-5","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T11:06:11Z","timestamp":1668683171000},"page":"2810-2817","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Accuracy of femoral tunnel positioning in medial patellofemoral ligament reconstruction: anatomic insertion leads to better clinical outcome"],"prefix":"10.1002","volume":"31","author":[{"given":"A.","family":"Maione","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Tradati","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> IRCCS Ospedale San Raffaele Via Olgettina 60 20132 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Ferrua","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"},{"name":"<!--<label>3<\/label>--> Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universit\u00e0 Degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1107-9298","authenticated-orcid":false,"given":"M.","family":"Ricci","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"},{"name":"<!--<label>4<\/label>--> Scuola Di Specializzazione in Ortopedia e Traumatologia Universit\u00e0 Degli Studi di Milano Via Festa del Perdono 7 20122 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Usellini","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.S.","family":"Randelli","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"},{"name":"<!--<label>3<\/label>--> Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universit\u00e0 Degli Studi di Milano Via Mangiagalli 31 20133 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Berruto","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> U.O.C. 1\u00b0 Clinica Ortopedica ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Piazza Cardinal Ferrari 1 20122 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515591265"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20102970\u20100"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101606336"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100039\u20101688917"},{"issue":"5","key":"e_1_2_10_6_2","first-page":"317","article-title":"Patella infera. 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July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare they do not have any conflict of interesting regarding the present study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the local Institutional Review Board (n\u00b0 870_2021).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients gave their informed consent to their participation in the 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