{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T19:30:35Z","timestamp":1773603035967,"version":"3.50.1"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Several combined procedures have been reported for treating recurrent patellofemoral instability (RPI) with various types and severity of morphological abnormalities, but none have identified absolute threshold values as indications for surgery. We performed medial patellofemoral ligament (MPFL) reconstruction combined with a modified Elmslie\u2013Trillat (ET) procedure on 24 knees (10 male and 11 female patients) to treat RPI with morphological abnormalities corresponding to elevated tibial tubercle\u2013trochlear groove (TT\u2013TG) distance, significant patella alta, and trochlear dysplasia. The inclusion criteria were RPI with morphological abnormalities corresponding to one or more of the following: sulcus angle\u2009&gt;\u2009160\u2009degrees, trochlear dysplasia of Dejour classification C or D, Caton\u2013Deschamps index\u2009&gt;\u20091.5, lateral shift ratio\u2009&gt;\u200950%, congruence angle\u2009&gt;\u200915\u2009degrees, or TT\u2013TG distance\u2009&gt;\u200920\u2009mm, including habitual dislocation of the patella. Skeletally immature patients and those with congenital dislocation of the patella were excluded. The Kujala score, International Knee Documentation Committee subjective score, Knee Injury and Osteoarthritis Outcome score (KOOS), and each item of the KOOS improved significantly after surgery. Patellar apprehension sign was present preoperatively in all cases, but all disappeared postoperatively. No instance of postoperative redislocation was observed. On radiographic examination, the mean Q angle, tilting angle, lateral shift ratio, congruence angle, Caton\u2013Deschamps index, Insall\u2013Salvati index, and TT\u2013TG distance improved significantly after surgery. There were no significant differences in sulcus angle after surgery. These results suggest MPFL reconstruction combined with a modified ET procedure provides satisfactory outcomes based on radiological and clinical evaluations for RPI with morphological abnormalities corresponding to elevated TT\u2013TG distance, significant patella alta, and trochlear dysplasia.<\/jats:p>","DOI":"10.1055\/a-2001-6565","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T00:35:58Z","timestamp":1671582958000},"page":"167-174","source":"Crossref","is-referenced-by-count":2,"title":["MPFL Reconstruction Combined with a Modified Elmslie\u2013Trillat Procedure for Recurrent Patellofemoral Instability"],"prefix":"10.1055","volume":"37","author":[{"given":"Genya","family":"Mitani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokai University Oiso Hospital, Naka-gun, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Serigano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomonori","family":"Takagaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Hamahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daichi","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuyuki","family":"Sogo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"ref1","first-page":"199","article-title":"Total tendon transplant for slipping patella: a new operation for recurrent dislocation of the patella","volume":"66","author":"E DW Hauser","year":"1938","journal-title":"Surg Gynecol Obstet"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2106\/00004623-197658010-00002","article-title":"Recurrent dislocation of the patella. 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