{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:08:13Z","timestamp":1793059693658,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate the biomechanical strength of two 4.5\u2010mm screws and three 3.5\u2010mm screws for fixation of the tibial tubercle after anteromedialization osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Anteromedialization of the tibial tubercle was performed on 5 pairs of fresh\u2010frozen cadaveric lower extremities. One leg from each pair was randomized to fixation with two 4.5\u2010mm screws and the contralateral leg to fixation with three 3.5\u2010mm screws. Each specimen was loaded cyclically to simulate an active straight\u2010leg raise and then to failure while displacement of the tubercle fragment was recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was no difference in mean tubercle fragment displacement under cyclic loading at any cycle number (\n                      <jats:italic>P<\/jats:italic>\n                      &gt; .352). Maximum failure load for osteotomies secured with two 4.5\u2010mm screws was 1,459 \u00b1 540 N, and for three 3.5\u2010mm screws it was 1,360 \u00b1 707 N. This was not a statistically significant difference (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .723). Tubercle migration of 7 mm was chosen as clinical failure. At this amount of displacement, mean load was 1,085 \u00b1 398 N and 764 \u00b1 313 N in the 4.5\u2010mm and 3.5\u2010mm groups, respectively, which was also not significantly different (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .146).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both 2\u00a0\u00d7 4.5\u2010mm and 3\u00a0\u00d7 3.5\u2010mm screw constructs after tibial tubercle anteromedialization are equally capable of withstanding physiologic forces like those encountered during an active straight\u2010leg raise and have similar failure strength.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Although both configurations are comparable, the use of the smaller 3.5\u2010mm screws may reduce the need for hardware removal related to prominence and soft tissue irritation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2013.06.020","type":"journal-article","created":{"date-parts":[[2013,8,29]],"date-time":"2013-08-29T20:00:19Z","timestamp":1377806419000},"page":"1628-1634","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":19,"title":["Comparison of Fixation Methods After Anteromedialization Osteotomy of the Tibial Tubercle for Patellar Instability"],"prefix":"10.1002","volume":"29","author":[{"given":"Brent T.","family":"Warner","sequence":"first","affiliation":[{"name":"Departments of Orthopaedics and Biomedical Engineering University of North Carolina School of Medicine Chapel Hill North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh V.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Biomedical Engineering University of North Carolina School of Medicine Chapel Hill North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey T.","family":"Spang","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Biomedical Engineering University of North Carolina School of Medicine Chapel Hill North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Weinhold","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Biomedical Engineering University of North Carolina School of Medicine Chapel Hill North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Alexander","family":"Creighton","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Biomedical Engineering University of North Carolina School of Medicine Chapel Hill North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,3]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280040601"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503260788"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197707000-00007"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658601400204"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00211"},{"key":"e_1_2_3_7_2","first-page":"2264","article-title":"Patellar instability","volume":"91","author":"Redziniak D.E.","year":"2009","journal-title":"J\u00a0Bone Joint Surg Am"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198307000-00027"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1248030"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465990270041601"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503258702"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500422"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1053\/otsm.2000.6581"},{"key":"e_1_2_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200011000-00033"},{"key":"e_1_2_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000130205.57095.a2"},{"key":"e_1_2_3_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100020108"},{"key":"e_1_2_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0268-0033(92)90023-W"},{"key":"e_1_2_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2006.08.009"},{"key":"e_1_2_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(85)90055-7"},{"key":"e_1_2_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659001800508"},{"key":"e_1_2_3_21_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198971060-00008"},{"key":"e_1_2_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(96)80138-0"},{"key":"e_1_2_3_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-9-98"},{"key":"e_1_2_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509357682"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806313008086?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806313008086?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2013.06.020","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2013.06.020","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2013.06.020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T08:36:25Z","timestamp":1773563785000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2013.06.020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,3]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2013,10]]}},"alternative-id":["10.1016\/j.arthro.2013.06.020"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2013.06.020","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Comparison of Fixation Methods After Anteromedialization Osteotomy of the Tibial Tubercle for Patellar Instability","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2013.06.020","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2013 Arthroscopy Association of North America. 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