{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:19:50Z","timestamp":1792498790038,"version":"4.5.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2009,6,2]],"date-time":"2009-06-02T00:00:00Z","timestamp":1243900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2009,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although patients considered \u201csuccessful\u201d at longer-term follow-up no longer exhibited patellar instability, those with more severe malalignment issues had other, gradually worsening symptoms such as activity-related pain, crepitation, swelling with activities, and pain with weather changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>Improvement of patellar tracking by correction of the tubercle-sulcus angle and related ligament deficiencies will result in good to excellent results, regardless of the technique employed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-five patients with dislocating patellae and significant lower leg deformity were treated; 12 patients (group 1) underwent a derotational high tibial osteotomy and 13 patients (group 2) underwent an Elmslie-Trillat-Fulkerson proximal-distal realignment. All were prospectively evaluated a minimum of 24 months postoperatively with a physical examination, validated outcome questionnaires, radiographs, and computerized axial tomography scans. Postoperative 3-dimensional bilateral gait analyses were performed on all subjects walking on a 3-dimensional force treadmill to measure stance kinematics, foot progression angle, knee flexion, knee valgus-varus, hip flexion, and patella angle. Contralateral limbs with similar preoperative alignment were used as controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Group 1 patients significantly improved over their preoperative status in all primary subjective and functional outcome parameters, and were significantly better than group 2 patients. Group 2 patients improved, but not to the degree of group 1 patients. Gait analysis revealed group 1 patients had more symmetrical gait patterns, with less variability and less compensatory gait changes, than group 2 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The original hypothesis proved to be incorrect. The simultaneous correction of ligament imbalance, excessive tubercle-sulcus angle, and lower limb torsional deformity produced significantly better results than conventional proximal-distal realignment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546509334223","type":"journal-article","created":{"date-parts":[[2009,6,2]],"date-time":"2009-06-02T22:00:02Z","timestamp":1243980002000},"page":"1288-1300","source":"Crossref","is-referenced-by-count":67,"title":["Surgical Correction of Limb Malalignment for Instability of the Patella"],"prefix":"10.1177","volume":"37","author":[{"given":"Lonnie","family":"Paulos","sequence":"first","affiliation":[{"name":"Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida"},{"name":"The Orthopedic Specialty Hospital, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Stoddard","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Barber-Westin","sequence":"additional","affiliation":[{"name":"Westin Research Consulting, Ft. 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