{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:21:16Z","timestamp":1792498876562,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T00:00:00Z","timestamp":1509408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T00:00:00Z","timestamp":1509408000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T00:00:00Z","timestamp":1509408000000},"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.fr","clinicalkey.com.au","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the impact elevated tibial tubercle\u2013trochlear groove (TT\u2010TG) distance and patella height, as measured by the Caton\u2010Deschamps Index (CDI), have on the isometry of a reconstructed medial patellofemoral ligament (MPFL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine fresh\u2010frozen cadaveric knees were placed on a custom testing fixture, with a fixed femur and a mobile tibia. A suture fixed to the MPFL origin on the patella and free to move at the Sch\u00f6ttle point on the femur represented a reconstructed MPFL. A local coordinate system was established, and retroreflective markers attached to the suture quantified MPFL length changes by use of a 3\u2010dimensional motion capture system. The tubercle was transferred to create TT\u2010TG distances of 20\u00a0mm and 25\u00a0mm and CDIs of 1.2 and 1.4 (patella alta). Recordings of the MPFL suture length change as the knee was brought through a range of motion were made using all combinations of tubercle anatomy in a randomized order for each specimen. A generalized estimating equation modeling technique was used to analyze and control for the clustered nature of the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Knees with native tibial tubercle anatomy showed MPFL isometry through 20\u00b0 to 70\u00b0 range of motion. Tibial tubercle lateralization (increased TT\u2010TG distance) significantly altered MPFL isometry with a TT\u2010TG distance of 20\u00a0mm\u00a0(\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .0001). Patella alta significantly altered MPFL isometry with a CDI of 1.2 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .0182). The interaction of tibial tubercle lateralization combined with patella alta significantly increased the amount of anisometry seen in the reconstructed MPFL (\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 tibial tubercle lateralization and patella alta produce anisometry in an MPFL reconstruction using currently recommended landmarks, leading to potentially increased graft tension and potential failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Tibial tubercle transfer should be considered when performing an MPFL reconstruction for recurrent patellofemoral instability in the setting of significant patella alta and an elevated TT\u2010TG distance\u2014especially when both are present\u2014because an isolated MPFL reconstruction will be prone to failure given the anisometry shown in this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2017.08.256","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T19:42:28Z","timestamp":1515094948000},"page":"502-510","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":65,"title":["Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Increased Tibial Tubercle\u2013Trochlear Groove Distance and Patella Alta"],"prefix":"10.1002","volume":"34","author":[{"given":"Lauren H.","family":"Redler","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Columbia University Medical Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen N.","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Biomechanics Hospital for Special Surgery New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Dennis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Columbia University Medical Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Hospital for Special Surgery New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth E.","family":"Shubin Stein","sequence":"additional","affiliation":[{"name":"Sports Medicine and Shoulder Service Hospital for Special Surgery New York New York"},{"name":"Department of Orthopedic Surgery Weill Cornell Medical College New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,31]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0b013e31803035ae"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B4.14768"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-0266(01)00008-0"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00508"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511404883"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513509058"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514554553"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"e_1_2_2_10_2","first-page":"387","article-title":"Patella alta in patellofemoral instability","volume":"55","author":"Geenen E.","year":"1989","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466050-00010"},{"key":"e_1_2_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)30581-2"},{"key":"e_1_2_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197210000-00012"},{"key":"e_1_2_2_14_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.185.3.1438776"},{"key":"e_1_2_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-0160(01)00136-3"},{"key":"e_1_2_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3865-4"},{"key":"e_1_2_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512449998"},{"key":"e_1_2_2_18_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1248123"},{"key":"e_1_2_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(94)90222-4"},{"key":"e_1_2_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515597906"},{"key":"e_1_2_2_21_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1564730"},{"key":"e_1_2_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-011-1516-y"},{"key":"e_1_2_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510376230"},{"key":"e_1_2_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514529640"},{"key":"e_1_2_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967116662873"},{"key":"e_1_2_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.12.029"},{"key":"e_1_2_2_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00759"},{"key":"e_1_2_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506296415"},{"key":"e_1_2_2_29_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200709000-00016"},{"key":"e_1_2_2_30_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138397"},{"key":"e_1_2_2_31_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B1.14924"},{"key":"e_1_2_2_32_2","unstructured":"Burrus MT Werner BC Cancienne JM Gwathmey FW Diduch DR. 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