{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:45:50Z","timestamp":1784821550393,"version":"3.55.0"},"reference-count":52,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.fr","clinicalkey.jp","arthroscopyjournal.org","clinicalkey.es","clinicalkey.com.au","clinicalkey.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>(1) To report the clinical and radiological outcomes of a surgical technique combining anatomic medial patellofemoral ligament reconstruction and tibia tuberosity transfer in adolescents with patella alta and elevated tibial tuberosity\u2010trochlear groove (TT\u2010TG) distance in the treatment of recurrent patellar dislocation; and (2) to investigate the potential risks of growth arrest or developmental deformities associated with this combined technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medical records of patients who underwent the combined surgery from 2015 to 2019 were reviewed. This study included adolescents aged between 14 and 18 years with a Caton\u2010Deschamps index (CDI) &gt; 1.30 and TT\u2010TG distance &gt;20 mm, with a minimum follow\u2010up of 4 years. Radiological examinations including lateral views and full\u2010length posteroanterior standing radiographs were investigated to assess patella height by CDI, posterior tibial slope (PTS) angle, side\u2010to\u2010side difference in bone length, and lower extremity alignment by hip\u2010knee\u2010ankle angle; computed tomography scans and magnetic resonance imaging profiles were investigated to evaluate TT\u2010TG distance and staging of growth plate closure. Other evaluations included preoperative and postoperative physical examination, Kujala score, and Tegner activity score. The patients were stratified into 3 subgroups according to an magnetic resonance imaging\u2013based staging system of the growth plate closure, and each outcome was analyzed. A cohort\u2010specific minimal clinically important difference estimation was performed using standard error of measurement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The average age at the time of surgery was 16.1 years (range, 14.1\u201017.8). The average follow\u2010up was 5.6 years (range, 4.0\u20107.6). No recurrent dislocation occurred, and no clinically significant deformity or axis deviation was encountered. Postoperative patellar height by CDI was 1.00 \u00b1 0.11 (range, 0.81\u20101.15). No significant differences were found in the preoperative and postoperative hip\u2010knee\u2010ankle angle or side\u2010to\u2010side difference in femur\/tibia length among all subgroups. A significantly decreased PTS angle was found in patients with open growth plates, from 10.2\u00b0 \u00b1 1.7\u00b0 before surgery to 8.1\u00b0 \u00b1 1.0\u00b0 after surgery (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .015). The Kujala score and Tegner score both significantly improved, from 65.5 \u00b1 13.9 before surgery to 90.4 \u00b1 7.2 after surgery in the Kujala score (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) and from 4.0 \u00b1 1.1 before surgery to 4.7 \u00b1 1.3 after surgery in the Tegner score (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Of the whole cohort, 63.1%, 100%, 47.1%, and 94.1% of patients achieved the minimal clinically important difference for PTS angle, CDI, Tegner score, and Kujala score, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This combined technique is safe and effective in treating recurrent patellar dislocation in skeletally mature adolescents with concurrent patella alta (CDI &gt; 1.30) and TT\u2010TG distance &gt;20 mm, permitting patients to have improved knee function and low complication rates. Nonetheless, patients with open growth plates demonstrated a decrease in PTS, which might predispose the knee to recurvatum and osteoarthritis in the long term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, controlled case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2023.09.001","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T03:04:45Z","timestamp":1694747085000},"page":"1529-1540","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":12,"title":["A Combined Surgical Approach for Recurrent Patellar Dislocation in Adolescents With Patella Alta and Increased Tibial Tuberosity\u2010Trochlear Groove Distance: Improved Clinical Outcomes but Decreased Posterior Tibial Slopes in Skeletally Immature Patients at Minimum 4\u2010Year 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