{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:01:40Z","timestamp":1785765700418,"version":"3.56.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsmedizin Greifswald"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Tibial tubercle osteotomy (TTO) is a common procedure used to treat patients with patellofemoral instability (PFI) and osteoarthritis (PFOA). Medial patellar maltracking due to previous excessive medialization of the tibial tubercle has rarely been reported. Therefore, the goal of this study was to assess patient-reported outcome measures (PROMs) after revision osteotomy with lateralization of the tibial tubercle (RL-TTO) to correct medial patellofemoral maltracking.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Between 2017 and 2021, a series of 11 patients (male\/female 1\/10; age 35.8\u2009\u00b1\u200910.5\u00a0years) were treated by RL-TTO, of whom 8 patients could be retrospectively evaluated after a mean of 32.4\u2009\u00b1\u200915.1\u00a0months (range 18\u201361\u00a0months) postoperatively. The Kujala anterior knee pain scale, the patellofemoral subscale of the Knee Osteoarthritis and Outcome Score (KOOS-PF), and a numeric analog scale (NAS; 0\u201310) regarding anterior knee pain (AKP) at rest and during activity were assessed from pre- to postoperatively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The preoperative mean tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances were \u2212\u00a06.5\u2009\u00b1\u20096.5\u00a0mm and 0.7\u2009\u00b1\u20094.6\u00a0mm, respectively. The intraoperatively determined amount of tibial tubercle lateralization averaged 10.7\u2009\u00b1\u20093.6\u00a0mm. The Kujala score and KOOS-PF improved significantly from 33.6\u2009\u00b1\u200910.1 (23\u201351) points to 94.4\u2009\u00b1\u20096.2 points (82\u2013100) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and from 20.6\u2009\u00b1\u200913.2 points (0\u201343.3) to 87.3\u2009\u00b1\u20099.9 points (72.8\u2013100) (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.001) from pre- to postoperatively, respectively. Pain at rest decreased from 5.8\u2009\u00b1\u20091.9 to 0.8\u2009\u00b1\u20090.9 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and pain during activity decreased from 8.6\u2009\u00b1\u20091.3 to 1.6\u2009\u00b1\u20091.5 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>RL-TTO significantly improved subjective knee function and AKP in patients suffering from medial patellar maltracking due to previous excessive tibial tubercle medialization osteotomy at short-term follow-up.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04700-1","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T16:58:23Z","timestamp":1669309103000},"page":"4323-4329","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Revision lateralization osteotomy of the tibial tubercle has excellent outcomes in patients suffering from previous medial tibial tubercle overcorrection"],"prefix":"10.1007","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-1927","authenticated-orcid":false,"given":"Sebastian","family":"Gebhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zimmerer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgi I.","family":"Wassilew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Balcarek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"4700_CR1","doi-asserted-by":"publisher","first-page":"2006","DOI":"10.1177\/0363546513507423","volume":"42","author":"SL Sherman","year":"2014","unstructured":"Sherman SL, Erickson BJ, Cvetanovich GL et al (2014) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med 42:2006\u20132017. https:\/\/doi.org\/10.1177\/0363546513507423","journal-title":"Am J Sports Med"},{"key":"4700_CR2","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1177\/036354659001800508","volume":"18","author":"JP Fulkerson","year":"1990","unstructured":"Fulkerson JP, Becker GJ, Meaney JA et al (1990) Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 18:490\u20136. https:\/\/doi.org\/10.1177\/036354659001800508 (discussion 496\u20137)","journal-title":"Am J Sports Med"},{"key":"4700_CR3","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/j.otsr.2020.03.020","volume":"106","author":"JDP van Sambeeck","year":"2020","unstructured":"van Sambeeck JDP, Rood A, Tigchelaar S et al (2020) Complications of a self-centering sliding tibial tubercle osteotomy for patellofemoral complaints; low incidence of non-union and fracture. Orthop Traumatol Surg Res 106:957\u2013961. https:\/\/doi.org\/10.1016\/j.otsr.2020.03.020","journal-title":"Orthop Traumatol Surg Res"},{"key":"4700_CR4","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1055\/s-0037-1603639","volume":"31","author":"PJJR Belmont","year":"2018","unstructured":"Belmont PJJR, Fisher TF, Bader JM et al (2018) Anteromedializing tibial tubercle osteotomy for patellofemoral instability: occupational and functional outcomes in U.S military service members. J Knee Surg 31:306\u2013313. https:\/\/doi.org\/10.1055\/s-0037-1603639","journal-title":"J Knee Surg"},{"key":"4700_CR5","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1302\/0301-620X.57B2.209","volume":"57","author":"WG Hampson","year":"1975","unstructured":"Hampson WG, Hill P (1975) Late results of transfer of the tibial tubercle for recurrent dislocation of the patella. J Bone Joint Surg Br 57:209\u2013213","journal-title":"J Bone Joint Surg Br"},{"key":"4700_CR6","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1302\/0301-620x.84b6.12804","volume":"84","author":"K Nakagawa","year":"2002","unstructured":"Nakagawa K, Wada Y, Minamide M et al (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861\u2013864. https:\/\/doi.org\/10.1302\/0301-620x.84b6.12804","journal-title":"J Bone Joint Surg Br"},{"key":"4700_CR7","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1302\/0301-620X.95B4.29681","volume":"95-B","author":"MA Naveed","year":"2013","unstructured":"Naveed MA, Ackroyd CE, Porteous AJ (2013) Long-term (ten- to 15-year) outcome of arthroscopically assisted Elmslie-Trillat tibial tubercle osteotomy. Bone Joint J 95-B:478\u2013485. https:\/\/doi.org\/10.1302\/0301-620X.95B4.29681","journal-title":"Bone Joint J"},{"key":"4700_CR8","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1177\/036354659702500417","volume":"25","author":"AJ Pidoriano","year":"1997","unstructured":"Pidoriano AJ, Weinstein RN, Buuck DA et al (1997) Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 25:533\u2013537. https:\/\/doi.org\/10.1177\/036354659702500417","journal-title":"Am J Sports Med"},{"key":"4700_CR9","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1016\/j.arthro.2015.03.028","volume":"31","author":"J Payne","year":"2015","unstructured":"Payne J, Rimmke N, Schmitt LC et al (2015) The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy 31:1819\u20131825. https:\/\/doi.org\/10.1016\/j.arthro.2015.03.028","journal-title":"Arthroscopy"},{"key":"4700_CR10","doi-asserted-by":"publisher","DOI":"10.1177\/03635465211012371","author":"DM Knapik","year":"2021","unstructured":"Knapik DM, Kunze KN, Azua E et al (2021) Radiographic and clinical outcomes after tibial tubercle osteotomy for the treatment of patella alta: a systematic review and meta-analysis. Am J Sports Med. https:\/\/doi.org\/10.1177\/03635465211012371","journal-title":"Am J Sports Med"},{"key":"4700_CR11","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.arthro.2015.10.019","volume":"32","author":"UG Longo","year":"2016","unstructured":"Longo UG, Rizzello G, Ciuffreda M et al (2016) Elmslie-trillat, maquet, fulkerson, roux goldthwait, and other distal realignment procedures for the management of patellar dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 32:929\u2013943. https:\/\/doi.org\/10.1016\/j.arthro.2015.10.019","journal-title":"Arthroscopy"},{"key":"4700_CR12","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/JSA.0b013e31825c74cf","volume":"20","author":"M Tompkins","year":"2012","unstructured":"Tompkins M, Arendt EA (2012) Complications in patellofemoral surgery. Sports Med Arthrosc Rev 20:187\u2013193. https:\/\/doi.org\/10.1097\/JSA.0b013e31825c74cf","journal-title":"Sports Med Arthrosc Rev"},{"key":"4700_CR13","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1302\/0301-620X.89B2.18358","volume":"89","author":"S Ko\u00ebter","year":"2007","unstructured":"Ko\u00ebter S, Diks MJF, Anderson PG et al (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 89:180\u2013185. https:\/\/doi.org\/10.1302\/0301-620X.89B2.18358","journal-title":"J Bone Joint Surg Br"},{"key":"4700_CR14","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/JSA.0b013e31828e88a2","volume":"21","author":"RK Harrison","year":"2013","unstructured":"Harrison RK, Magnussen RA, Flanigan DC (2013) Avoiding complications in patellofemoral surgery. Sports Med Arthrosc Rev 21:121\u2013128. https:\/\/doi.org\/10.1097\/JSA.0b013e31828e88a2","journal-title":"Sports Med Arthrosc Rev"},{"key":"4700_CR15","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s00402-018-2881-5","volume":"138","author":"D Dammerer","year":"2018","unstructured":"Dammerer D, Liebensteiner MC, Kujala UM et al (2018) Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study. Arch Orthop Trauma Surg 138:527\u2013535. https:\/\/doi.org\/10.1007\/s00402-018-2881-5","journal-title":"Arch Orthop Trauma Surg"},{"key":"4700_CR16","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1136\/bjsports-2016-096776","volume":"52","author":"KM Crossley","year":"2018","unstructured":"Crossley KM, Macri EM, Cowan SM et al (2018) The patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF): development and validation using the COSMIN checklist. Br J Sports Med 52:1130\u20131136. https:\/\/doi.org\/10.1136\/bjsports-2016-096776","journal-title":"Br J Sports Med"},{"key":"4700_CR17","doi-asserted-by":"publisher","first-page":"2146","DOI":"10.1016\/j.arthro.2019.02.030","volume":"35","author":"SA Klinge","year":"2019","unstructured":"Klinge SA, Fulkerson JP (2019) Fifteen-year minimum follow-up of anteromedial tibial tubercle transfer for lateral and\/or distal patellofemoral arthrosis. Arthroscopy 35:2146\u20132151. https:\/\/doi.org\/10.1016\/j.arthro.2019.02.030","journal-title":"Arthroscopy"},{"key":"4700_CR18","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/JSA.0000000000000151","volume":"25","author":"AA Johnson","year":"2017","unstructured":"Johnson AA, Cosgarea AJ, Wolfe EL (2017) Complications of tibial tuberosity osteotomy. Sports Med Arthrosc Rev 25:85\u201391. https:\/\/doi.org\/10.1097\/JSA.0000000000000151","journal-title":"Sports Med Arthrosc Rev"},{"key":"4700_CR19","first-page":"E396","volume":"46","author":"BM Saltzman","year":"2017","unstructured":"Saltzman BM, Rao A, Erickson BJ et al (2017) A systematic review of 21 tibial tubercle osteotomy studies and more than 1000 knees: indications, clinical outcomes, complications, and reoperations. Am J Orthop (Belle Mead NJ) 46:E396\u2013E407","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"4700_CR20","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/BF01552649","volume":"2","author":"H Dejour","year":"1994","unstructured":"Dejour H, Walch G, Nove-Josserand L et al (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19\u201326. https:\/\/doi.org\/10.1007\/BF01552649","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4700_CR21","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1177\/036354658801600413","volume":"16","author":"JC Hughston","year":"1988","unstructured":"Hughston JC, Deese M (1988) Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 16:383\u2013388. https:\/\/doi.org\/10.1177\/036354658801600413","journal-title":"Am J Sports Med"},{"key":"4700_CR22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/01.blo.0000238831.50186.87","volume":"452","author":"EDW Hauser","year":"2006","unstructured":"Hauser EDW (2006) Total tendon transplant for slipping patella: a new operation for recurrent dislocation of the patella. 1938. Clin Orthop Relat Res 452:7\u201316. https:\/\/doi.org\/10.1097\/01.blo.0000238831.50186.87","journal-title":"Clin Orthop Relat Res"},{"key":"4700_CR23","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1177\/036354658201000509","volume":"10","author":"JS Cox","year":"1982","unstructured":"Cox JS (1982) Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Am J Sports Med 10:303\u2013310. https:\/\/doi.org\/10.1177\/036354658201000509","journal-title":"Am J Sports Med"},{"key":"4700_CR24","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1097\/00003086-198307000-00027","volume":"177","author":"JP Fulkerson","year":"1983","unstructured":"Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176\u2013181","journal-title":"Clin Orthop Relat Res"},{"key":"4700_CR25","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1302\/0301-620X.97B3.34515","volume":"97-B","author":"S Tigchelaar","year":"2015","unstructured":"Tigchelaar S, van Essen P, B\u00e9rnard M, Koeter S, Wymenga A (2015) A self-cenering osteotomy of the tibial tubercle for patella maltracking or instability. Bone Joint J 97-B:329\u2013336","journal-title":"Bone Joint J"},{"key":"4700_CR26","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1177\/0363546511427117","volume":"40","author":"C Mayer","year":"2012","unstructured":"Mayer C, Magnussen RA, Servien E et al (2012) Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta. Am J Sports Med 40:346\u2013351. https:\/\/doi.org\/10.1177\/0363546511427117","journal-title":"Am J Sports Med"},{"key":"4700_CR27","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1302\/0301-620X.89B2.18358","volume":"89-B","author":"S Koeter","year":"2007","unstructured":"Koeter S, Diks MJF, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg [Br] 89-B:180\u2013185","journal-title":"J Bone Joint Surg [Br]"},{"key":"4700_CR28","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1007\/BF00451317","volume":"103","author":"RMG Juliusson","year":"1984","unstructured":"Juliusson RMG (1984) A modified hauser procedure for recurrent dislocation of the patella: a long-term follow-up study with special reference to osteoarthritis. Arch Orthop Trauma Surg 103:42\u201346","journal-title":"Arch Orthop Trauma Surg"},{"key":"4700_CR29","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1302\/0301-620X.67B2.3980537","volume":"67","author":"N Nakamura","year":"1985","unstructured":"Nakamura N, Ellis M, Seedhom BB (1985) Advancement of the tibial tuberosity. A biomechanical study. J Bone Joint Surg Br 67:255\u2013260. https:\/\/doi.org\/10.1302\/0301-620X.67B2.3980537","journal-title":"J Bone Joint Surg Br"},{"key":"4700_CR30","first-page":"671","volume":"69","author":"JA Gruskay","year":"2020","unstructured":"Gruskay JA, Gomoll AH, Arendt EA et al (2020) Patellar instability and dislocation: optimizing surgical treatment and how to avoid complications. Instr Course Lect 69:671\u2013692","journal-title":"Instr Course Lect"},{"key":"4700_CR31","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.csm.2021.07.008","volume":"41","author":"EC Gardner","year":"2022","unstructured":"Gardner EC, Molho DA, Fulkerson JP (2022) Coronal malalignment-when and how to perform a tibial tubercle osteotomy. Clin Sports Med 41:15\u201326. https:\/\/doi.org\/10.1016\/j.csm.2021.07.008","journal-title":"Clin Sports Med"},{"key":"4700_CR32","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1055\/s-0039-3402077","volume":"34","author":"M Barahona","year":"2021","unstructured":"Barahona M, Guzm\u00e1n M, Barrientos C et al (2021) The distance between tibial tubercle and trochlear groove correlates with knee articular torsion. J Knee Surg 34:918\u2013923. https:\/\/doi.org\/10.1055\/s-0039-3402077","journal-title":"J Knee Surg"},{"key":"4700_CR33","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1302\/2633-1462.33.BJO-2021-0107","volume":"3","author":"H Krishnan","year":"2022","unstructured":"Krishnan H, Eldridge JD, Clark D et al (2022) Tibial tuberosity-trochlear groove distance: does it measure up? Bone Jt Open 3:268\u2013274. https:\/\/doi.org\/10.1302\/2633-1462.33.BJO-2021-0107","journal-title":"Bone Jt Open"},{"key":"4700_CR34","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1007\/s00402-020-03375-w","volume":"140","author":"A Rood","year":"2020","unstructured":"Rood A, van Sambeeck J, Ko\u00ebter S et al (2020) A detaching, V-shaped tibial tubercle osteotomy is a safe procedure with a low complication rate. Arch Orthop Trauma Surg 140:1867\u20131872. https:\/\/doi.org\/10.1007\/s00402-020-03375-w","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04700-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04700-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04700-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T19:13:06Z","timestamp":1687806786000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04700-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,23]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["4700"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04700-1","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,23]]},"assertion":[{"value":"27 July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 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 have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the ethical committee Baden-W\u00fcrttemberg, Germany.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participant provided informed consent for publication of the image in Fig.\u00a0.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}}]}}