{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:07:32Z","timestamp":1785146852383,"version":"3.55.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"14","license":[{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Medial patellofemoral ligament (MPFL) reconstruction is associated with high complication rates because of graft overloading from incorrect graft positioning. To improve clinical outcomes, it is crucial to gain a better understanding of MPFL elongation patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To assess MPFL length changes in healthy knees from 0\u00b0 to 90\u00b0 of dynamic flexion and their relationship with anatomic parameters of the patellofemoral joint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Descriptive laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Dynamic computed tomography scans of an active flexion-extension-flexion movement in 115 knees from 63 healthy participants were evaluated to construct knee joint models. Using these models, the MPFL length was measured as the shortest wrapping path from the Sch\u00f6ttle point on the femur to 3 insertion points on the superomedial border of the patella (proximal, central, and distal). MPFL length changes (%) relative to the length in full extension were calculated, and their correlations with the tibial tuberosity\u2013trochlear groove distance, Caton-Deschamps index, and lateral trochlear inclination were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The proximal fiber was the longest in full extension and progressively decreased to a median length of \u22126.0% at 90\u00b0 of flexion. The central fiber exhibited the most isometric pattern during knee flexion, showing a median maximal decrease of 2.8% relative to the full extension length and no evident elongation. The distal fiber first slightly decreased in length but increased at deeper flexion angles. The median overall length changes were 4.6, 4.7, and 5.7 mm for the proximal, central, and distal patellar insertion, respectively. These values were either not or very weakly correlated with the tibial tuberosity\u2013trochlear groove distance, Caton-Deschamps index, and lateral trochlear inclination when the anatomic parameters were within the healthy range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The median MPFL length changed by approximately 5 mm between 0\u00b0 and 90\u00b0 of flexion. Proximally, the length continuously decreased, indicating slackening behavior. Distally, the length increased at deeper flexion angles, indicating tightening behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>In MPFL reconstruction techniques utilizing the Sch\u00f6ttle point to establish the femoral insertion, one should avoid distal patellar insertion, as it causes elongation of the ligament, which may increase the risk for complications due to overloading.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231205597","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T02:28:27Z","timestamp":1699928907000},"page":"3724-3731","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Length Changes of the Medial Patellofemoral Ligament During In Vivo Knee Motion: An Evaluation Using Dynamic Computed Tomography"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0442-1091","authenticated-orcid":false,"given":"Miriam R.","family":"Boot","sequence":"first","affiliation":[{"name":"Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiaan A.W.","family":"van de Groes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Dunning","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Tanck","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Janssen","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,11,13]]},"reference":[{"key":"bibr1-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4272-1"},{"key":"bibr2-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1080\/10255840512331388010"},{"key":"bibr3-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.187.1.8451415"},{"key":"bibr4-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.216.2.r00au07582"},{"key":"bibr5-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2020.01.012"},{"key":"bibr6-03635465231205597","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199305000-00007"},{"key":"bibr7-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-021-00430-2"},{"key":"bibr8-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"bibr9-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2022.12.011"},{"key":"bibr10-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506287486"},{"key":"bibr11-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20827"},{"key":"bibr12-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-014-1156-8"},{"key":"bibr13-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1043-2"},{"key":"bibr14-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519841304"},{"key":"bibr15-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-05999-2"},{"key":"bibr16-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517724417"},{"key":"bibr17-03635465231205597","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2022.820196"},{"key":"bibr18-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519840278"},{"key":"bibr19-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2009.2035616"},{"key":"bibr20-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2018.2845918"},{"key":"bibr21-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118766275"},{"key":"bibr22-03635465231205597","doi-asserted-by":"publisher","DOI":"10.3390\/app11114771"},{"key":"bibr23-03635465231205597","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2003.33.11.677"},{"key":"bibr24-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.08.256"},{"key":"bibr25-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/036354659602400110"},{"key":"bibr26-03635465231205597","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v8.i2.115"},{"key":"bibr27-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/1941738117725055"},{"key":"bibr28-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506296415"},{"key":"bibr29-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512442330"},{"key":"bibr30-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-0160(03)00038-3"},{"key":"bibr31-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514567061"},{"key":"bibr32-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512449998"},{"key":"bibr33-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231165296"},{"key":"bibr34-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-008-0702-z"},{"key":"bibr35-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520916435"},{"key":"bibr36-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512453301"},{"key":"bibr37-03635465231205597","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000028511"}],"container-title":["The 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