{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:41:22Z","timestamp":1790739682842,"version":"4.1.0"},"reference-count":66,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T00:00:00Z","timestamp":1554249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T00:00:00Z","timestamp":1554249600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T00:00:00Z","timestamp":1554249600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T00:00:00Z","timestamp":1554249600000},"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":[[2019,6]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine the effect of knee flexion angle during graft fixation on outcomes and complications following medial patellofemoral ligament (MPFL) reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three databases (PubMed, EMBASE, and MEDLINE) were searched from database inception to January 2018. After screening based on inclusion and exclusion criteria, patient demographics, fixation technique, graft selection, outcomes, and complications were extracted from the included studies. The studies were grouped based on flexion angle used during graft fixation: low (0\u00b0\u201030\u00b0) and high (45\u00b0\u201090\u00b0) flexion angle group. Methodological Index for Non\u2010Randomized Studies criteria were used to assess the quality of each included study. Descriptive statistics are presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen studies (of 3,399) were included and were either cohort (n\u00a0= 1) or case series (n\u00a0= 17) study designs. A total of 556 patients with a mean age of 23.6\u00a0years (range, 10\u201060\u00a0years) underwent MPFL reconstructions, with 458 patients in the 0\u00b0 to 30\u00b0 fixation group and 98 in the 45\u00b0 to 90\u00b0 fixation group. The mean Kujala score improved from 45 to 72.9 (365 patients) preoperatively to 83 to 94.5 (460 patients) postoperatively for the 0\u00b0 to 30\u00b0 fixation group and from 53.3 to 72 preoperatively to 92.2 to 95.2 postoperatively for the 45\u00b0 to 90\u00b0 fixation group (98 patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The knee flexion angle during MPFL graft fixation ranges from 20\u00b0 to 90\u00b0. Graft fixation at low and high knee flexion angles during MPFL reconstruction showed excellent patient\u2010reported outcomes and low patellar redislocation rates overall, with no clear differences between the 2 groups based on the currently available data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, systematic review of Level III\u2010IV studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2018.11.071","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T11:18:34Z","timestamp":1554376714000},"page":"1893-1904","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":36,"title":["Knee Flexion Angle During Graft Fixation for Medial Patellofemoral Ligament Reconstruction: A Systematic Review of Outcomes and Complications"],"prefix":"10.1002","volume":"35","author":[{"given":"Neel K.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"de SA","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Vaswani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Kay","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Musahl","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryson P.","family":"Lesniak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515577786"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00072"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.otsm.2006.08.001"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280040601"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-0160(03)00006-1"},{"key":"e_1_2_3_8_2","first-page":"24","article-title":"Biomechanical evaluation of lateral patellar dislocations","volume":"11","author":"Burks R.T.","year":"1998","journal-title":"Am J Knee Surg"},{"key":"e_1_2_3_9_2","first-page":"17","article-title":"Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: An MRI study","volume":"1","author":"Guerrero P.","year":"2009","journal-title":"Sports Med Arthrosc Rehab Ther Tech"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510397174"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3182471ac2"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453679708996255"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967114544021"},{"key":"e_1_2_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/BLO.0b013e31802eb40a"},{"key":"e_1_2_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.11.040"},{"key":"e_1_2_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.09.002"},{"key":"e_1_2_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117751659"},{"key":"e_1_2_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2014.07.023"},{"key":"e_1_2_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517745625"},{"key":"e_1_2_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515624673"},{"key":"e_1_2_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512442330"},{"key":"e_1_2_3_22_2","doi-asserted-by":"publisher","DOI":"10.5792\/ksrr.2015.27.3.133"},{"key":"e_1_2_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.11.027"},{"key":"e_1_2_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546505285584"},{"key":"e_1_2_3_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-009-0918-7"},{"key":"e_1_2_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-007-0300-4"},{"key":"e_1_2_3_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-004-0607-4"},{"key":"e_1_2_3_28_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874210601004010084"},{"key":"e_1_2_3_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4783-4"},{"key":"e_1_2_3_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnx020"},{"key":"e_1_2_3_32_2","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_3_33_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_2_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80366-4"},{"key":"e_1_2_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(03)00613-0"},{"key":"e_1_2_3_36_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200406000-00004"},{"key":"e_1_2_3_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658201000306"},{"key":"e_1_2_3_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20632"},{"key":"e_1_2_3_39_2","first-page":"43","article-title":"Rating systems in the evaluation of knee ligament injuries","author":"Tegner Y.","year":"1985","journal-title":"Clin Orthop Rel Res."},{"key":"e_1_2_3_40_2","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177729756"},{"key":"e_1_2_3_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3020-7"},{"key":"e_1_2_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510377436"},{"key":"e_1_2_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2014.05.006"},{"key":"e_1_2_3_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513477828"},{"key":"e_1_2_3_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3005-6"},{"key":"e_1_2_3_46_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-011-1609-7"},{"key":"e_1_2_3_47_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-014-0066-7"},{"key":"e_1_2_3_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.04.017"},{"key":"e_1_2_3_49_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514529640"},{"key":"e_1_2_3_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512463683"},{"key":"e_1_2_3_51_2","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.905583"},{"key":"e_1_2_3_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511420079"},{"key":"e_1_2_3_53_2","first-page":"1","article-title":"Medial patellofemoral ligament reconstruction in children: Do osseous abnormalities matter?","author":"Pesenti S.","year":"2018","journal-title":"Int Orthop."},{"key":"e_1_2_3_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509333482"},{"key":"e_1_2_3_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jajs.2015.09.001"},{"key":"e_1_2_3_56_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4111-4"},{"key":"e_1_2_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.09.047"},{"key":"e_1_2_3_58_2","first-page":"125","article-title":"Strain within the native and reconstructed MPFL during knee flexion","volume":"27","author":"McCulloch P.C.","year":"2014","journal-title":"J\u00a0Knee Surg"},{"key":"e_1_2_3_59_2","first-page":"15","article-title":"Patellofemoral anatomy and biomechanics: Current concepts","volume":"1","author":"Zaffagnini S.","year":"2013","journal-title":"Joints"},{"key":"e_1_2_3_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2004.09.008"},{"key":"e_1_2_3_61_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513509230"},{"key":"e_1_2_3_62_2","first-page":"820","article-title":"Biomechanics and pathomechanics of the patellofemoral joint","volume":"11","author":"Loudon J.K.","year":"2016","journal-title":"Int J Sports Phys Ther"},{"key":"e_1_2_3_63_2","first-page":"38","article-title":"Functional outcomes of MPFL reconstruction vs. graft tissue placement","volume":"34","author":"Larson E.","year":"2014","journal-title":"Iowa Orthop J"},{"key":"e_1_2_3_64_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506287486"},{"key":"e_1_2_3_65_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-014-2437-4"},{"key":"e_1_2_3_66_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2015-5"},{"key":"e_1_2_3_67_2","first-page":"E249","article-title":"Knee range of motion: Reliability and agreement of 3 measurement methods","volume":"40","author":"Peters P.G.","year":"2011","journal-title":"Am J Orthop (Belle Mead, N.J.)"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806318311800?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806318311800?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.2018.11.071","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2018.11.071","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2018.11.071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:10:04Z","timestamp":1773565804000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2018.11.071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,3]]},"references-count":66,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1016\/j.arthro.2018.11.071"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2018.11.071","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Knee Flexion Angle During Graft Fixation for Medial Patellofemoral Ligament Reconstruction: A Systematic Review of Outcomes and Complications","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.2018.11.071","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}