{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T22:58:14Z","timestamp":1789340294059,"version":"build-2803163510"},"reference-count":51,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques\u2014including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)\u2014which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed\/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)\/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria.<\/jats:p>","DOI":"10.3390\/jcm14041376","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T03:29:53Z","timestamp":1739935793000},"page":"1376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Unlocking the Mystery of Patella Dislocation\u2014Diagnostic Methods in Pediatric Populations: A Comprehensive Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8553-695X","authenticated-orcid":false,"given":"Ewa","family":"Tram\u015b","sequence":"first","affiliation":[{"name":"Department of Musculoskeletal Trauma and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacy","family":"To\u0142wi\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Musculoskeletal Trauma and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Tyrakowski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-7061","authenticated-orcid":false,"given":"Dariusz","family":"Grzelecki","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-3923","authenticated-orcid":false,"given":"Jacek","family":"Kowalczewski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-3596","authenticated-orcid":false,"given":"Rafa\u0142","family":"Kami\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Musculoskeletal Trauma and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1177\/0363546503260788","article-title":"Epidemiology and Natural History of Acute Patellar Dislocation","volume":"32","author":"Fithian","year":"2004","journal-title":"Am. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"463","DOI":"10.2106\/JBJS.G.00072","article-title":"Acute Patellar Dislocation in Children and Adolescents: A Randomized Clinical Trial","volume":"90","author":"Palmu","year":"2008","journal-title":"J. Bone Jt. Surg.-Am. Vol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/01241398-199407000-00018","article-title":"Acute Patellar Dislocation in Children: Incidence and Associated Osteochondral Fractures","volume":"14","author":"Nietosvaara","year":"1994","journal-title":"J. Pediatr. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3109\/17453670903110634","article-title":"The Mechanism of Primary Patellar Dislocation: Trauma History of 126 Patients","volume":"80","author":"Nikku","year":"2009","journal-title":"Acta Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1177\/0363546512472873","article-title":"Predictors of Recurrent Instability After Acute Patellofemoral Dislocation in Pediatric and Adolescent Patients","volume":"41","author":"Lewallen","year":"2013","journal-title":"Am. J. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/BPO.0000000000000674","article-title":"Predictors of Recurrent Patellar Instability in Children and Adolescents After First-Time Dislocation","volume":"37","author":"Jaquith","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/BPO.0000000000001188","article-title":"3D Knee Trochlear Morphology Assessment by Magnetic Resonance Imaging in Patients With Normal and Dysplastic Trochleae","volume":"40","author":"Pennock","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1177\/0363546516663498","article-title":"Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children","volume":"45","author":"Askenberger","year":"2017","journal-title":"Am. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.ejrad.2010.06.042","article-title":"Patellar Dislocations in Children, Adolescents and Adults: A Comparative MRI Study of Medial Patellofemoral Ligament Injury Patterns and Trochlear Groove Anatomy","volume":"79","author":"Balcarek","year":"2011","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3566","DOI":"10.1007\/s00167-018-4997-0","article-title":"Tibial Tubercle\u2013Trochlear Groove Distance and Angle Are Higher in Children with Patellar Instability","volume":"26","author":"Bayhan","year":"2018","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Choi, W., Lee, S.-J., Oh, J., Baek, H., Yang, J., Shin, J., Jung, B., and Lee, S. (2021). Magnetic Resonance Imaging of Patellofemoral Morphometry Reveals Age and Gender Variations in the Knees of Children and Adolescents. Diagnostics, 11.","DOI":"10.3390\/diagnostics11111985"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e388","DOI":"10.1097\/BPO.0000000000001035","article-title":"Evaluation of the Tibial Tubercle to Posterior Cruciate Ligament Distance in a Pediatric Patient Population","volume":"37","author":"Clifton","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"318","DOI":"10.2106\/JBJS.M.00688","article-title":"Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population","volume":"96","author":"Dickens","year":"2014","journal-title":"J. Bone Jt. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1097\/BPO.0000000000000556","article-title":"Developmental Morphology in Childhood Patellar Instability: Age-Dependent Differences on Magnetic Resonance Imaging","volume":"36","author":"Gustavsson","year":"2016","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/BPO.0000000000002629","article-title":"Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-Time Acute Lateral Patellar Dislocation in Adolescents: An MRI-Based Evaluation","volume":"44","author":"Topkar","year":"2024","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1007\/s00247-016-3574-2","article-title":"Patellofemoral Instability in Children: T2 Relaxation Times of the Patellar Cartilage in Patients with and without Patellofemoral Instability and Correlation with Morphological Grading of Cartilage Damage","volume":"46","author":"Kang","year":"2016","journal-title":"Pediatr. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.2214\/AJR.15.15217","article-title":"Patellofemoral Instability in Children: Correlation Between Risk Factors, Injury Patterns, and Severity of Cartilage Damage","volume":"206","author":"Kim","year":"2016","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23259671221145228","DOI":"10.1177\/23259671221145228","article-title":"Reliability of the TT-TG Index Versus TT-TG Distance on MRI: Morphometric Analyses in Asian Children and Adolescents","volume":"11","author":"Park","year":"2023","journal-title":"Orthop. J. Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/03635465231165521","article-title":"Normative Values of Tibial Tubercle\u2013Trochlear Groove Distance and Tibial Tubercle\u2013Posterior Cruciate Ligament Distance in Children","volume":"51","author":"Park","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/BPO.0b013e3182471ac2","article-title":"Magnetic Resonance Imaging of Acute Patellar Dislocation in Children: Patterns of Injury and Risk Factors for Recurrence","volume":"32","author":"Seeley","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Schranz, C., Belohlavek, T., Sperl, M., Kraus, T., and Svehlik, M. (2021). Does Femoral Anteversion and Internally Rotated Gait Correlate in Subjects with Patellofemoral Instability?. Clin. Biomech., 84.","DOI":"10.1016\/j.clinbiomech.2021.105333"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1177\/1602400226","article-title":"Tibial Tubercle to Trochlear Groove Distance and Index in Children with One-Time versus Recurrent Patellar Dislocation: A Magnetic Resonance Imaging Study","volume":"24","author":"Yeoh","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"181","DOI":"10.4103\/ijri.IJRI_222_16","article-title":"Evaluation of Patella Alta Using MRI Measurements in Adolescents","volume":"27","author":"Yilmaz","year":"2017","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.clinimag.2016.11.010","article-title":"A Magnetic Resonance Imaging Study of Abnormalities of the Patella and Patellar Tendon That Predispose Children to Acute Patellofemoral Dislocation","volume":"42","year":"2017","journal-title":"Clin. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.injury.2015.02.001","article-title":"Injury Patterns of Medial Patellofemoral Ligament and Correlation Analysis with Articular Cartilage Lesions of the Lateral Femoral Condyle after Acute Lateral Patellar Dislocation in Children and Adolescents: An MRI Evaluation","volume":"46","author":"Zheng","year":"2015","journal-title":"Injury"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1016\/j.injury.2020.10.065","article-title":"Gender-Related Differences in Concomitant Articular Injuries after Acute Lateral Patellar Dislocation","volume":"52","author":"Zheng","year":"2021","journal-title":"Injury"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e628","DOI":"10.1097\/BPO.0000000000001890","article-title":"Utility of the Merchant View Radiograph for Assessment of Tibial Tubercle-Trochlear Groove Distance: A Comparison to MRI in Pediatric and Adolescent Patients","volume":"41","author":"Bernholt","year":"2021","journal-title":"J. Pediatr. Orthop."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/BPB.0b013e3283474c8b","article-title":"Radiological Criteria for Trochlear Dysplasia in Children and Adolescents","volume":"20","author":"Lippacher","year":"2011","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"232596711666949","DOI":"10.1177\/2325967116669490","article-title":"Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?","volume":"4","author":"Stepanovich","year":"2016","journal-title":"Orthop. J. Sports Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/BPO.0000000000000120","article-title":"Can Turned Inward Patella Predict an Excess of Femoral Anteversion During Gait in Spastic Diplegic Children?","volume":"34","author":"Simon","year":"2014","journal-title":"J. Pediatr. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ma\u0142ecki, K., Fabi\u015b-Strobin, A., Sa\u0142aci\u0144ska, K., Kwas, K., Stelmach, W., Beczkowski, J., Niedzielski, K., and Gach, A. (2023). Clinical Significance of Polymorphisms of Genes Encoding Collagen (COL1A1, COL5A1) and Their Correlation with Joint Laxity and Recurrent Patellar Dislocation in Adolescents. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-49378-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"23259671231180574","DOI":"10.1177\/23259671231180574","article-title":"Comparison of Habitual Versus Recurrent Patellar Dislocation in Children and Adolescents: Differences in Radiological Features","volume":"11","author":"Huang","year":"2023","journal-title":"Orthop. J. Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.knee.2005.06.003","article-title":"The Tibial Tuberosity\u2013Trochlear Groove Distance; a Comparative Study between CT and MRI Scanning","volume":"13","author":"Schoettle","year":"2006","journal-title":"Knee"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/00004728-200111000-00021","article-title":"Medial Patellofemoral Ligament Injury Following Acute Transient Dislocation of the Patella: MR Findings with Surgical Correlation in 14 Patients","volume":"25","author":"Sanders","year":"2001","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Koh, J.L., Kuroda, R., Espregueira-Mendes, J., and Gobbi, A. (2022). Imaging Evaluation in the Patient with Patellofemoral Symptoms. The Patellofemoral Joint, Springer International Publishing.","DOI":"10.1007\/978-3-030-81545-5"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.otsr.2014.12.001","article-title":"Acute Traumatic Patellar Dislocation","volume":"101","author":"Duthon","year":"2015","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/1941738114543073","article-title":"Evaluation and Management of Patellar Instability in Pediatric and Adolescent Athletes","volume":"7","author":"Khormaee","year":"2015","journal-title":"Sports Health A Multidiscip. Approach"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/BF01552649","article-title":"Factors of Patellar Instability: An Anatomic Radiographic Study","volume":"2","author":"Dejour","year":"1994","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.2106\/JBJS.20.01624","article-title":"Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pain and Instability in a Skeletally Mature Population","volume":"103","author":"DeVries","year":"2021","journal-title":"J. Bone Jt. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/01241398-199701000-00012","article-title":"The Cartilaginous Femoral Sulcus in Children with Patellar Dislocation: An Ultrasonographic Study","volume":"17","author":"Nietosvaara","year":"1997","journal-title":"J. Pediatr. Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0968-0160(02)00002-9","article-title":"Correlation of MR Imaging Findings and Open Exploration of Medial Patellofemoral Ligament Injuries in Acute Patellar Dislocations","volume":"9","author":"Nomura","year":"2002","journal-title":"Knee"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"103160","DOI":"10.1016\/j.otsr.2021.103160","article-title":"Trochleoplasty: Indications in Patellar Dislocation with High-Grade Dysplasia. Surgical Technique","volume":"108","author":"Dejour","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Dejour, D., Zaffagnini, S., Arendt, E.A., Sillanp\u00e4\u00e4, P., and Dirisamer, F. (2020). Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment, Springer.","DOI":"10.1007\/978-3-662-61097-8"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1007\/s00264-020-04652-4","article-title":"Acute Instability of the Patella: Is Magnetic Resonance Imaging Mandatory?","volume":"44","author":"Saragaglia","year":"2020","journal-title":"Int. Orthop. (SICOT)"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1177\/03635465990270050601","article-title":"Axial and Lateral Radiographs in Evaluating Patellofemoral Malalignment","volume":"27","author":"Murray","year":"1999","journal-title":"Am. J. Sports Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1097\/CORR.0000000000000886","article-title":"Classifications in Brief: The Dejour Classification of Trochlear Dysplasia","volume":"477","author":"Kazley","year":"2019","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1177\/0284185114524391","article-title":"Mapping of the Femoral Trochlea in a Newborn Population: An Ultrasonographic Study","volume":"56","author":"Holen","year":"2015","journal-title":"Acta Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1055\/s-2004-861764","article-title":"Cartilage MRI T2 Relaxation Time Mapping: Overview and Applications","volume":"08","author":"Mosher","year":"2004","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.2214\/AJR.09.4019","article-title":"T2 Relaxation Time Changes in Distal Femoral Articular Cartilage in Children With Juvenile Idiopathic Arthritis: A 3-Year Longitudinal Study","volume":"195","author":"Kim","year":"2010","journal-title":"Am. J. Roentgenol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Zhao, H., Li, H., Liang, S., Wang, X., and Yang, F. (2022). T2 Mapping for Knee Cartilage Degeneration in Young Patients with Mild Symptoms. BMC Med. Imaging, 22.","DOI":"10.1186\/s12880-022-00799-1"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1148\/radiol.09090335","article-title":"Quantitative T2 Mapping of Knee Cartilage: Differentiation of Healthy Control Cartilage and Cartilage Repair Tissue in the Knee with Unloading\u2014Initial Results","volume":"254","author":"Mamisch","year":"2010","journal-title":"Radiology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:37:30Z","timestamp":1760027850000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,19]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041376"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041376","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,19]]}}}