{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:45:59Z","timestamp":1793317559085,"version":"4.5.0"},"reference-count":51,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100007307","name":"Arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009026","name":"Smith and Nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009026","name":"Smith and Nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"DePuy"},{"DOI":"10.13039\/100007307","name":"Arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]}],"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":[[2019,2]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the midterm clinical outcomes of anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction (TTO+MPFLR) with MPFLR alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with a tibial tuberosity\u2013trochlear groove (TT\u2010TG) of 17 to 20\u00a0mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From January 2008 to August 2013, patients with RPI and a TT\u2010TG of 17 to 20\u00a0mm were divided into 2 groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1\u20104+); patellar glide (1\u20104+); the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT\u2010TG; and Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. Kujala improvement was the primary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010two subjects were evaluated, 18 in the TTO+MPFLR group and 24 in the MPFLRa group. Mean follow\u2010up time was 40.86\u00a0months (range, 24\u201060\u00a0months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification; patellar glide; the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT\u2010TG; and Kujala, Lysholm, IKDC, and Tegner scores. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively, were 1 and 1.33 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .006). Improvement was significantly higher in the TTO+MPFLR group in all scores except for\u00a0Tegner. Kujala improvement, 30.27 and 23.95, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .003), was also clinically significant, favoring TTO+MPFLR. Lysholm improvement was 40.5 and 36.2, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .02), and IKDC improvement was 38.59 and 31.6, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.002). There were no reported recurrent subluxations or dislocations in either group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared with MPFLRa in the surgical treatment of RPI in patients with a TT\u2010TG distance of 17 to 20\u00a0mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, prospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2018.10.109","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T01:26:57Z","timestamp":1546565217000},"page":"566-574","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":131,"title":["Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity\u2013Trochlear Groove Distance of 17 to 20\u00a0mm"],"prefix":"10.1002","volume":"35","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"},{"name":"Knee Institute Hospital do Cora\u00e7\u00e3o S\u00e3o Paulo SP Brazil"},{"name":"Hospital Israelita Albert Einstein S\u00e3o Paulo SP 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