{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:45:43Z","timestamp":1793317543790,"version":"4.5.0"},"reference-count":52,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Surgery is the primary treatment for recurrent patellar dislocation. However, there is still a lack of consensus regarding the choice of combined surgical methods due to the complexity of the anatomical factors. This study aimed to investigate the efficacy and radiological changes in medial patellofemoral ligament reconstruction (MPFLR) and lateral retinacular release (LRR) with and without tibial tubercle osteotomy (TTO) for recurrent patellar dislocation in patients with a tibial tubercle-trochlear groove (TT-TG) distance of 15 to 20\u2009mm. Fifty-four patients were enrolled in this retrospective study between 2010 and 2014. The average patient age was 21.6\u2009\u00b1\u20095.0 years. All patients underwent MPFLR and LRR, and in 18 patients, these procedures were combined with TTO. Patients were evaluated preoperatively and postoperatively for patellar lateral shift, patellar tilt angle, TT-TG distance, Q-angle, Caton\u2013Deschamps index (CDI), Kujala, and Lysholm scores. The minimally clinical important difference was used to compare clinical outcomes between two groups. In the mean follow-up of 82.6\u2009\u00b1\u200915.9 months, functional scores improved significantly in both groups (p\u2009&lt;\u20090.01). There were no significant differences in postoperative function scores between the two groups (Kujala, p\u2009=\u20090.25, mean difference\u2009=\u20091.5, 95% confidence interval [CI]: \u20131.4\u20134.4; Lysholm, p\u2009=\u20090.76, mean difference\u2009=\u2009\u20130.6, 95% CI: \u20135.9\u20134.7). Additionally, TTO significantly decreased Q-angle (23.6\u2009\u00b1\u20092.4 vs. 17.4\u2009\u00b1\u20092.9, p\u2009&lt;\u20090.01), TT-TG (17.1\u2009\u00b1\u20091.5 vs. 10.4\u2009\u00b1\u20091.8, p\u2009&lt;\u20090.01), and CDI (1.18\u2009\u00b1\u20090.12 vs. 1.08\u2009\u00b1\u20090.07, p\u2009&lt;\u20090.01). Combined MPFLR and LRR with and without TTO are both effective techniques for recurrent patellar dislocation. Additional osteotomy can correct patellar alta and tibial tubercle lateralization. However, given that there were no significant differences in postoperative functional scores or recurrence rate between groups, we may not recommend TTO in addition to MPFLR and LRR in patients with TT-TG of 15 to 20\u2009mm. Long-term and prospective cohort studies are required to assess further outcomes.<\/jats:p>","DOI":"10.1055\/s-0042-1757593","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T00:43:10Z","timestamp":1671842590000},"page":"1349-1356","source":"Crossref","is-referenced-by-count":10,"title":["Addition of Tibial Tubercle Osteotomy to Combined MPFL Reconstruction and Lateral Retinacular Release not Recommended for Recurrent Patellar Dislocation in Patients with 15 to 20\u2009mm TT-TG"],"prefix":"10.1055","volume":"36","author":[{"given":"Yuankai","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Nan","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"},{"name":"Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qichun","family":"Song","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Fan","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhibin","family":"Shi","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqian","family":"Dang","sequence":"additional","affiliation":[{"name":"The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"3849","DOI":"10.1007\/s00167-016-4346-0","article-title":"Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability","volume":"25","author":"L A Hiemstra","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1055\/s-0036-1579675","article-title":"Imaging of individual anatomical risk factors for patellar instability","volume":"20","author":"T J Dietrich","year":"2016","journal-title":"Semin Musculoskelet Radiol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1177\/0363546514563904","article-title":"The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study","volume":"43","author":"R N Steensen","year":"2015","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/0363546512464691","article-title":"Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations","volume":"41","author":"G Diederichs","year":"2013","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/BF01552649","article-title":"Factors of patellar instability: an anatomic radiographic study","volume":"2","author":"H Dejour","year":"1994","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/0363546519841304","article-title":"Properties and function of the medial patellofemoral ligament: a systematic review","volume":"48","author":"C Huber","year":"2020","journal-title":"Am J 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Orthop"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00264-019-04441-8","article-title":"Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation-a mean follow-up of 5.4 years","volume":"44","author":"P M Tscholl","year":"2020","journal-title":"Int Orthop"},{"issue":"10","key":"ref14","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1007\/s00167-011-1832-2","article-title":"Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation","volume":"20","author":"E Tsuda","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1302\/0301-620X.89B2.18358","article-title":"A modified tibial tubercle osteotomy for patellar 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Arthrosc"},{"issue":"11","key":"ref18","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s00402-020-03556-7","article-title":"Clinical outcomes of medial retinaculum plasty versus MPFL reconstruction with concomitant tibial tubercle transfer: a retrospective study","volume":"140","author":"X Feng","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1007\/s00167-015-3654-0","article-title":"Clinical outcome in MPFL reconstruction with and without tuberositas transposition","volume":"25","author":"A Mulliez","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/JSA.0b013e31803035ae","article-title":"Osteotomies in patello-femoral instabilities","volume":"15","author":"D Dejour","year":"2007","journal-title":"Sports Med Arthrosc 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Med"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.knee.2004.05.003","article-title":"A new technique for reconstructing the medial patellofemoral ligament","volume":"12","author":"A J Cossey","year":"2005","journal-title":"Knee"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/0363546516666352","article-title":"Medial patellofemoral ligament reconstruction combined with distal realignment for recurrent dislocations of the patella: 5-year results of a randomized controlled trial","volume":"45","author":"I Damasena","year":"2017","journal-title":"Am J Sports Med"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00402-020-03689-9","article-title":"Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review","volume":"141","author":"F Migliorini","year":"2021","journal-title":"Arch Orthop Trauma 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