{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:19:53Z","timestamp":1792498793134,"version":"4.5.0"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,12,14]],"date-time":"2016-12-14T00:00:00Z","timestamp":1481673600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,12,14]],"date-time":"2016-12-14T00:00:00Z","timestamp":1481673600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2016,12,14]],"date-time":"2016-12-14T00:00:00Z","timestamp":1481673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","arthroscopyjournal.org","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To verify the influence that increased femoral anteversion (FA) has on patients with recurrent patellar instability (RPI) treated by anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to present the midterm outcomes of these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From January 2008 to August 2013, skeletally mature patients with RPI and tibial tubercle (TT)\u2013trochlear groove (TG) \u2265 17\u00a0mm who underwent anteromedialization TTO combined with MPFLR were evaluated for J sign, patellar glide, apprehension test, increased FA, Caton index, trochlea dysplasia, TT\u2010TG, Kujala, International Knee Documentation Committee subjective knee evaluation form, and Tegner. Increased FA was determined clinically by a difference of more than 30\u00b0 between hip internal and external rotation, 70\u00b0 or more of hip internal rotation, and 30\u00b0 or more of femoral neck anteversion. A subgroup analysis involving increased FA was made.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010eight patients composed the study group. Mean follow\u2010up was 41.5 \u00b1 11.05\u00a0months. The J\u2010sign was present in 86% before surgery and none postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). All patients had a positive apprehension test or a patellar luxation at the patellar glide test rated as grade 4 before surgery. After surgery, the mean glide was 1.29 \u00b1 0.45 with no apprehension (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Increased FA was present in 18.7%. Caton index before surgery was 1.11 \u00b1 0.21 and 0.99 \u00b1 0.11 postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .004). Trochlea dysplasia was present in all patients. TT\u2010TG preoperatively was 20.77 \u00b1 2.12\u00a0mm and 11.33 \u00b1 1.24\u00a0mm postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Functional scores improved preoperatively to postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) with Kujala and International Knee Documentation Committee means: 59.08 to 84.37; 52.6 to 85.5, respectively. Tegner preinjury score was 5.4 and postoperatively was 5.2 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .01). Increased FA group had worse Kujala compared with the normal FA group and worse Kujala improvement: 77.7 and 85.89 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .012), and 21.7 and 26.1, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased FA in patients with RPI had a negative effect on the outcome of anteromedialization TTO combined with MPFLR. Combined anteromedialization TTO and MPFLR had good functional midterm outcomes in treating patients with RPI and TT\u2010TG \u2265 17 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2016.09.015","type":"journal-article","created":{"date-parts":[[2016,12,14]],"date-time":"2016-12-14T17:52:09Z","timestamp":1481737929000},"page":"633-640","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":107,"title":["Increased Femoral Anteversion Influence Over Surgically Treated Recurrent Patellar Instability Patients"],"prefix":"10.1002","volume":"33","author":[{"given":"Carlos Eduardo","family":"Franciozi","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Felipe","family":"Ambra","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Jos\u00e9 Bernardes","family":"Albertoni","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Debieux","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Cury","family":"Rezende","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio Ayres de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Hospital Regional P\u00fablico do Leste Paragominas PA Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio de Castro","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Hospital do Cora\u00e7\u00e3o S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Vin\u00edcius Malheiros","family":"Luzo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Escola Paulista de Medicina Federal University of S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12,14]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00211"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354657600400204"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0749-8063(92)90064-I"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-015-2381-9"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659001800508"},{"key":"e_1_2_2_8_2","unstructured":"Mulliez A Lambrecht D Verbruggen D Van Der Straeten C Verdonk P Victor J. 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