Approach to Patellar Dislocation Treatment: Review and Prospects

Abstract

Lateral patellar dislocation (LPD) is a musculoskeletal condition characterized by a complex etiology. Despite significant advancements in management strategies, it continues to pose considerable challenges. Critical anatomic risk factors previously identified include trochlear dysplasia (TD), patella alta, and elevated tibial tubercle–trochlear groove (TT-TG) distance, with TD being the most significant. A thorough risk assessment using predictive models is primarily recommended to assist in patient counseling and to identify high-risk cases, for whom early surgical intervention may be considered. Controversies persist regarding the indications for combined surgical procedures, including tibial tubercle osteotomy (TTO), derotational distal femoral osteotomy (DDFO), and lateral retinacular release (LRR) with medial patellofemoral reconstruction (MPFLR). Moreover, emerging evidence suggests that a deeper understanding of the interplay between anatomic factors may optimize surgical prioritization and improve clinical outcomes. The combined surgical approach should be reserved for meticulously selected cases with substantial anatomic risk factors, while isolated MPFLR may prove adequate for cases with milder grade risk factors. To enhance individualized treatment strategies and improve outcomes for patients with LPD, deeper insights into the interaction of anatomical factors, supported by higher-quality clinical research and advancements in biomechanical modeling, are essential.

Keywords

biomechanical modeling / lateral patellar dislocation / MPFL reconstruction / risk stratification / tibial tubercle osteotomy / trochlear dysplasia

References

[1] V. Dewan, M. S. L. Webb, D. Prakash, A. Malik, S. Gella, and C. Kipps, “Patella Dislocation: An Online Systematic Video Analysis of the Mechanism of Injury,” Knee Surgery & Related Research 32 (2020): 24, https://doi.org/10.1186/S43019-020-00031-W.

[2] K. S. Gravesen, T. Kallemose, L. Blønd, A. Troelsen, and K. W. Barfod, “High Incidence of Acute and Recurrent Patellar Dislocations: A Retrospective Nationwide Epidemiological Study Involving 24.154 Primary Dislocations,” Knee Surgery, Sports Traumatology, Arthroscopy 26 (2018): 1204-1209, https://doi.org/10.1007/S00167-017-4594-7.

[3] D. C. Fithian, E. W. Paxton, M. L. Stone, et al., “Epidemiology and Natural History of Acute Patellar Dislocation,” American Journal of Sports Medicine 32 (2004): 1114-1121, https://doi.org/10.1177/0363546503260788.

[4] S. Batra and S. Arora, “Habitual Dislocation of Patella: A Review,” J Clin Orthop Trauma 5 (2014): 245-251, https://doi.org/10.1016/J.JCOT.2014.09.006.

[5] D. A. Abelleyra Lastoria, B. Kenny, S. Dardak, C. Brookes, and C. B. Hing, “Is the Patella Apprehension Test a Valid Diagnostic Test for Patellar Instability? A Systematic Review,” Journal of Orthopaedics 42 (2023): 54-62, https://doi.org/10.1016/J.JOR.2023.07.005.

[6] D. H. Dejour, G. Mesnard, and E. Giovannetti de Sanctis, “Updated Treatment Guidelines for Patellar Instability: un Menu à la Carte,” Journal of Experimental Orthopaedics 8 (2021): 1-11, https://doi.org/10.1186/s40634-021-00430-2.

[7] A. E. White, P. T. Otlans, D. P. Horan, et al., “Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-Analysis,” Orthopaedic Journal of Sports Medicine 9, no. 5 (2021), https://doi.org/10.1177/2325967121993179.

[8] L. A. Hiemstra, S. Kerslake, M. Lafave, S. M. Heard, and G. M. L. Buchko, “Introduction of a Classification System for Patients With Patellofemoral Instability (WARPS and STAID),” Knee Surgery, Sports Traumatology, Arthroscopy 22 (2014): 2776-2782, https://doi.org/10.1007/s00167-013-2477-0.

[9] P. Balcarek, S. Oberthür, S. Hopfensitz, et al., “Which Patellae Are Likely to Redislocate?,” Knee Surgery, Sports Traumatology, Arthroscopy 22 (2014): 2308-2314, https://doi.org/10.1007/S00167-013-2650-5.

[10] M. Hevesi, M. J. Heidenreich, C. L. Camp, et al., “The Recurrent Instability of the Patella Score: A Statistically Based Model for Prediction of Long-Term Recurrence Risk After First-Time Dislocation,” Arthroscopy 35 (2019): 537-543, https://doi.org/10.1016/J.ARTHRO.2018.09.017.

[11] C. Huber, Q. Zhang, W. R. Taylor, A. A. Amis, C. Smith, and S. H. Hosseini Nasab, “Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review,” American Journal of Sports Medicine 48 (2020): 754-766, https://doi.org/10.1177/0363546519841304.

[12] C. K. Fitzpatrick, R. N. Steensen, A. Tumuluri, T. Trinh, J. Bentley, and P. J. Rullkoetter, “Computational Analysis of Factors Contributing to Patellar Dislocation,” Journal of Orthopaedic Research 34 (2016): 444-453, https://doi.org/10.1002/jor.23041.

[13] B. P. Jaquith and S. N. Parikh, “Predictors of Recurrent Patellar Instability in Children and Adolescents After First-Time Dislocation,” Journal of Pediatric Orthopaedics 37 (2017): 484-490, https://doi.org/10.1097/BPO.0000000000000674.

[14] E. A. Arendt, M. Askenberger, J. Agel, and M. A. Tompkins, “Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables,” American Journal of Sports Medicine 46 (2018): 3385-3390, https://doi.org/10.1177/0363546518803936.

[15] G. Wierer, N. Krabb, P. Kaiser, et al., “The Patellar Instability Probability Calculator: A Multivariate-Based Model to Predict the Individual Risk of Recurrent Lateral Patellar Dislocation,” American Journal of Sports Medicine 50 (2022): 471-477, https://doi.org/10.1177/03635465211063176.

[16] J. Yu, Y. Li, K. Zhang, et al., “The Accuracy of Multiple Regression Models for Predicting the Individual Risk of Recurrent Lateral Patellar Dislocation,” BMC Musculoskeletal Disorders 24 (2023): 948, https://doi.org/10.1186/S12891-023-07094-2.

[17] M. Nelitz, S. Lippacher, H. Reichel, and D. Dornacher, “Evaluation of Trochlear Dysplasia Using MRI: Correlation Between the Classification System of Dejour and Objective Parameters of Trochlear Dysplasia,” Knee Surgery, Sports Traumatology, Arthroscopy 22 (2014): 120-127, https://doi.org/10.1007/S00167-012-2321-Y.

[18] T. C. Christensen, T. L. Sanders, A. Pareek, R. Mohan, D. L. Dahm, and A. J. Krych, “Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations,” American Journal of Sports Medicine 45 (2017): 2105-2110, https://doi.org/10.1177/0363546517704178.

[19] D. Weltsch, C. T. Chan, R. J. Mistovich, et al., “Predicting Risk of Recurrent Patellofemoral Instability With Measurements of Extensor Mechanism Containment,” American Journal of Sports Medicine 49 (2021): 706-712, https://doi.org/10.1177/0363546520987007.

[20] R. J. Mistovich, J. W. Urwin, P. D. Fabricant, and J. T. R. Lawrence, “Patellar Tendon-Lateral Trochlear Ridge Distance: A Novel Measurement of Patellofemoral Instability,” American Journal of Sports Medicine 46 (2018): 3400-3406, https://doi.org/10.1177/0363546518809982.

[21] J. Chen, Z. Ye, C. Wu, X. Zhang, J. Zhao, and G. Xie, “Patellar Shift Ratio (PSR) is the Optimal Measurement for Characterising Lateral Patellar Shift and a Reliable Predictor of Recurrent Patellar Dislocation,” Knee Surgery, Sports Traumatology, Arthroscopy 31 (2023): 2818-2827, https://doi.org/10.1007/S00167-022-07240-8.

[22] A. Klasan, R. Compagnoni, A. Grassi, and J. Menetrey, “Promising Results Following Derotational Femoral Osteotomy in Patellofemoral Instability With Increased Femoral Anteversion: A Systematic Review on Current Indications, Outcomes and Complication Rate,” Journal of Experimental Orthopaedics 11 (2024): e12032, https://doi.org/10.1002/JEO2.12032.

[23] G. W. Flores, D. F. de Oliveira, A. P. S. Ramos, et al., “Conservative Management Following Patellar Dislocation: A Level I Systematic Review,” Journal of Orthopaedic Surgery and Research 18 (2023): 393, https://doi.org/10.1186/S13018-023-03867-6.

[24] R. A. Magnussen, M. Verlage, E. Stock, et al., “Primary Patellar Dislocations Without Surgical Stabilization or Recurrence: How Well Are These Patients Really Doing?,” Knee Surgery, Sports Traumatology, Arthroscopy 25 (2017): 2352-2356, https://doi.org/10.1007/S00167-015-3716-3.

[25] G. Pagliazzi, F. Napoli, D. Previtali, G. Filardo, S. Zaffagnini, and C. Candrian, “A Meta-Analysis of Surgical Versus Nonsurgical Treatment of Primary Patella Dislocation,” Arthroscopy 35 (2019): 2469-2481, https://doi.org/10.1016/J.ARTHRO.2019.03.047.

[26] D. Y. Lee, D. G. Kang, H. S. Jo, S. J. Heo, J. H. Bae, and S. C. Hwang, “A Systematic Review and Meta-Analysis Comparing Conservative and Surgical Treatments for Acute Patellar Dislocation in Children and Adolescents,” Knee Surgery & Related Research 16 (2023): 378, https://doi.org/10.1186/S43019-023-00189-Z.

[27] M. Liebensteiner, A. Keiler, R. El Attal, et al., “Conservative Versus Tailored Surgical Treatment in Patients With First Time Lateral Patella Dislocation: A Randomized-Controlled Trial,” Journal of Orthopaedic Surgery and Research 16 (2021): 378, https://doi.org/10.1186/S13018-021-02513-3.

[28] M. Tompkins and E. A. Arendt, “Complications in Patellofemoral Surgery,” Sports Medicine and Arthroscopy Review 20 (2012): 187-193, https://doi.org/10.1097/JSA.0B013E31825C74CF.

[29] B. N. Platt, L. C. Bowers, J. A. Magnuson, et al., “Return to Sport After Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis,” American Journal of Sports Medicine 50 (2022): 282-291, https://doi.org/10.1177/0363546521990004.

[30] F. Migliorini, F. Oliva, G. D. Maffulli, et al., “Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellofemoral Instability: Analysis of Outcomes and Risk Factors,” Journal of Orthopaedic Surgery and Research 16 (2021): 239, https://doi.org/10.1186/S13018-021-02383-9.

[31] J. N. Shah, J. S. Howard, D. C. Flanigan, R. H. Brophy, J. L. Carey, and C. Lattermann, “A Systematic Review of Complications and Failures Associated With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation,” American Journal of Sports Medicine 40 (2012): 1916-1923, https://doi.org/10.1177/0363546512442330.

[32] P. C. Ryan, B. J. Ross, M. A. Stamm, W. F. Sherman, W. M. R. Heard, and M. K. Mulcahey, “Concomitant Tibial Tubercle Osteotomy Reduces the Risk of Revision Surgery After Medial Patellofemoral Ligament Reconstruction for the Treatment of Patellar Instability,” Arthroscopy 39 (2023): 2037-2045, https://doi.org/10.1016/J.ARTHRO.2023.02.006.

[33] Z. I. Li, S. Garra, J. Eskenazi, et al., “Patients Who Undergo Tibial Tubercle Anteromedialization With Medial Patellofemoral Ligament Reconstruction Demonstrate Similar Rates of Return to Sport Compared to Isolated MPFL Reconstruction,” Knee Surgery, Sports Traumatology, Arthroscopy 32 (2024): 371-380, https://doi.org/10.1002/KSA.12051.

[34] P. Vivekanantha, H. Kahlon, D. Cohen, and D. de Sa, “Isolated Medial Patellofemoral Ligament Reconstruction Results in Similar Postoperative Outcomes as Medial Patellofemoral Ligament Reconstruction and Tibial-Tubercle Osteotomy: A Systematic Review and Meta-Analysis,” Knee Surgery, Sports Traumatology, Arthroscopy 31 (2023): 2433-2445, https://doi.org/10.1007/s00167-022-07186-x.

[35] B. Guevel, A. Njai, A. Raboff, A. Hillman, M. Barton, and M. S. Kocher, “Does Tibial Tuberosity Osteotomy Improve Outcomes When Combined With Medial Patellofemoral Ligament Reconstruction in the Presence of Increased Tibial Tuberosity-Trochlear Groove Distance? A Systematic Review and Meta-Analysis,” Orthopaedic Journal of Sports Medicine 11, no. 12 (2023), https://doi.org/10.1177/23259671231195905.

[36] X. Meng, Z. Ji, P. Wu, et al., “Combining Tibial Tubercle Osteotomy With Medial Patellofemoral Ligament Reconstruction Often Yields Better Outcomes in Treating Patellofemoral Instability: A Systematic Review and Meta-Analysis of Case-Control Studies,” Journal of Orthopaedic Surgery and Research 19 (2024): 695, https://doi.org/10.1186/s13018-024-05113-z.

[37] K. Zhou, P. Bai, Z. Sun, et al., “Distalization of Tibial Tubercle Osteotomy Is Not Necessary for Patients With Recurrent Patellar Dislocation Accompanied by Patella Alta and Increased TT-TG Distance,” BMC Musculoskeletal Disorders 23 (2022): 838, https://doi.org/10.1186/S12891-022-05779-8.

[38] L. A. Hiemstra, S. Kerslake, M. R. Lafave, and A. Tucker, “Patella Alta Is Reduced Following MPFL Reconstruction but Has no Effect on Quality-Of-Life Outcomes in Patients With Patellofemoral Instability,” Knee Surgery, Sports Traumatology, Arthroscopy 29 (2021): 546-552, https://doi.org/10.1007/S00167-020-05977-8.

[39] S. S. W. Shih, C. L. Kuo, and D. Y. H. Lee, “MPFL Reconstruction Corrects Patella Alta: A Cohort Study,” European Journal of Orthopaedic Surgery and Traumatology 32 (2022): 883-889, https://doi.org/10.1007/S00590-021-03056-3.

[40] R. T. Kreulen, G. Anderson, S. Yalcin, et al., “Evaluation of Differences in Patellar Height After Patellar Stabilization Procedures Not Intended to Address Patella Alta: A Multicenter Study,” Orthopaedic Journal of Sports Medicine 12, no. 3 (2024), https://doi.org/10.1177/23259671241235597.

[41] P. P. Roessler, M. D. Wimmer, C. Jacobs, R. Bornemann, T. Stein, and M. Lahner, “Medial Patellofemoral Ligament Reconstruction Fails to Correct Mild Patella Alta in Cases of Patellofemoral Instability—A Case-Control Study,” International Orthopaedics 43 (2019): 2071-2075, https://doi.org/10.1007/S00264-018-4162-X.

[42] J. S. Yang, J. P. Fulkerson, E. Obopilwe, et al., “Patellofemoral Contact Pressures After Patellar Distalization: A Biomechanical Study,” Arthroscopy 33 (2017): 2038-2044, https://doi.org/10.1016/J.ARTHRO.2017.06.043.

[43] M. R. Davies, S. Allahabadi, T. E. Diab, et al., “Sulcus-Deepening Trochleoplasty as an Isolated or Combined Treatment Strategy for Patellar Instability and Trochlear Dysplasia: A Systematic Review,” Arthrosc Sports Med Rehabil 2 (2020): e661-e669, https://doi.org/10.1016/J.ASMR.2020.06.009.

[44] C. M. P. Tan, Y. Zhu, L. Guo, and S. Y. J. Loh, “Medial Patellofemoral Ligament Reconstruction With and Without Trochleoplasty for Patients With Patella Instability-Correlation of Trochlear Dysplasia and Patient Outcome, Classification and Outcome Measure in the Past Decade—A Systematic Review,” European Journal of Orthopaedic Surgery and Traumatology 32 (2022): 595-607, https://doi.org/10.1007/S00590-021-03030-Z.

[45] J. N. Liu, J. M. Brady, I. L. Kalbian, et al., “Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia,” American Journal of Sports Medicine 46 (2018): 883-889, https://doi.org/10.1177/0363546517745625.

[46] C. K. Fitzpatrick, R. N. Steensen, O. Alvarez, A. E. Holcomb, and P. J. Rullkoetter, “Computational Comparison of Medializing Tibial Tubercle Osteotomy and Trochleoplasty in Patients With Trochlear Dysplasia,” Journal of Orthopaedic Research 41 (2023): 1687-1696, https://doi.org/10.1002/JOR.25519.

[47] J. T. Leclerc, J. Dartus, J. Labreuche, et al., “Complications and Outcomes of Trochleoplasty for Patellofemoral Instability: A Systematic Review and Meta-Analysis of 1000 Trochleoplasties,” Orthopaedics & Traumatology, Surgery & Research 107, no. 7 (2021), https://doi.org/10.1016/J.OTSR.2021.103035.

[48] L. A. Hiemstra, D. Peterson, M. Youssef, J. Soliman, L. Banfield, and O. R. Ayeni, “Trochleoplasty Provides Good Clinical Outcomes and an Acceptable Complication Profile in Both Short and Long-Term Follow-Up,” Knee Surgery, Sports Traumatology, Arthroscopy 27 (2019): 2967-2983, https://doi.org/10.1007/S00167-018-5311-X.

[49] M. Nelitz, J. Dreyhaupt, and S. Lippacher, “Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations in Severe Trochlear Dysplasia: A Minimum 2-Year Follow-Up Study,” American Journal of Sports Medicine 41 (2013): 1005-1012, https://doi.org/10.1177/0363546513478579.

[50] M. C. Liebensteiner, J. Ressler, G. Seitlinger, T. Djurdjevic, R. El Attal, and P. W. Ferlic, “High Femoral Anteversion Is Related to Femoral Trochlea Dysplasia,” Arthroscopy 32 (2016): 2295-2299, https://doi.org/10.1016/J.ARTHRO.2016.03.023.

[51] H. Kang, C. Dong, G. Tian, and F. Wang, “A Computed Tomography Study of the Association Between Increased Patellar Tilt Angle and Femoral Anteversion in 30 Patients With Recurrent Patellar Dislocation,” Medical Science Monitor 25 (2019): 4370-4376, https://doi.org/10.12659/MSM.914747.

[52] G. Tian, G. Yang, L. Zuo, F. Li, and F. Wang, “Femoral Derotation Osteotomy for Recurrent Patellar Dislocation,” Archives of Orthopaedic and Trauma Surgery 140 (2020): 2077-2084, https://doi.org/10.1007/S00402-020-03598-X.

[53] Z. Huo, K. Hao, C. Fan, Y. Niu, H. Bai, and W. Bai, “Derotational Distal Femur Osteotomy With Medial Patellofemoral Ligament Reconstruction Can Get Good Outcomes in the Treatment of Recurrent Patellar Dislocation With Excessive TT-TG and Increased Femoral Anteversion,” Frontiers in Surgery 11 (2024): 1392947, https://doi.org/10.3389/FSURG.2024.1392947.

[54] K. I. Barton, K. R. Boldt, O. A. Sogbein, et al., “Femoral Internal Torsion Greater Than Twenty-Five Degrees and/or External Tibial Torsion Greater Than Thirty Degrees as Measured by Computed Tomography Are Threshold Values for Axial Alignment Correction in Patellofemoral Instability,” Journal of ISAKOS 9 (2024): 386-393, https://doi.org/10.1016/J.JISAKO.2024.02.002.

[55] R. Manilov, J. Chahla, S. Maldonado, B. Altintas, M. Manilov, and B. Zampogna, “High Tibial Derotation Osteotomy for Distal Extensor Mechanism Alignment in Patients With Squinting Patella due to Increased External Tibial Torsion,” Knee 27 (2020): 1931-1941, https://doi.org/10.1016/J.KNEE.2020.10.006.

[56] Y. Cao, Z. Zhang, J. Shen, et al., “Derotational Distal Femoral Osteotomy Yields Satisfactory Clinical Outcomes in Pathological Femoral Rotation With Failed Medial Patellofemoral Ligament Reconstruction,” Knee Surgery, Sports Traumatology, Arthroscopy 30 (2022): 1809-1817, https://doi.org/10.1007/S00167-021-06739-W.

[57] K. Zhou, Z. Sun, A. Feng, et al., “Derotational Distal Femur Osteotomy Combined With Medial Patellofemoral Ligament Reconstruction Yields Satisfactory Results in Recurrent Patellar Dislocation With Excessive Femoral Anteversion Angle and Trochlear Dysplasia,” Knee Surgery, Sports Traumatology, Arthroscopy 31 (2023): 4347-4354, https://doi.org/10.1007/S00167-023-07476-Y.

[58] K. Hao, Y. Niu, L. Kong, and F. Wang, “Medial Patellofemoral Ligament Reconstruction Combined With Derotational Distal Femoral Osteotomy Yields Better Outcomes Than Isolated Procedures in Patellar Dislocation With Increased Femoral Anteversion,” Knee Surgery, Sports Traumatology, Arthroscopy 31 (2023): 2888-2896, https://doi.org/10.1007/S00167-022-07264-0.

[59] J. Yang, J. Zhong, H. Li, et al., “Medial Patellar Ligament Reconstruction in Combination With Derotational Distal Femoral Osteotomy for Treating Recurrent Patellar Dislocation in the Presence of Increased Femoral Anteversion: A Systematic Review,” Journal of Orthopaedic Surgery and Research 19 (2024): 1-8, https://doi.org/10.1186/S13018-024-04709-9.

[60] Z. J. Zhang, Y. Cao, G. Song, Y. Li, T. Zheng, and H. Zhang, “Derotational Femoral Osteotomy for Treating Recurrent Patellar Dislocation in the Presence of Increased Femoral Anteversion: A Systematic Review,” Orthopaedic Journal of Sports Medicine 9, no. 11 (2021), https://doi.org/10.1177/23259671211057126.

[61] X. L. Wang, C. Peng, Y. W. Tu, et al., “Effects of Lateral Patellar Retinaculum Release for Recurrent Patella Dislocation: A Prospective Study,” International Journal of General Medicine 14 (2021): 5527-5535, https://doi.org/10.2147/IJGM.S329026.

[62] F. Migliorini, N. Maffulli, J. Eschweiler, V. Quack, M. Tingart, and A. Driessen, “Lateral Retinacular Release Combined With MPFL Reconstruction for Patellofemoral Instability: A Systematic Review,” Archives of Orthopaedic and Trauma Surgery 141 (2021): 283-292, https://doi.org/10.1007/S00402-020-03689-9.

[63] T. L. Waters, E. M. Miller, E. C. Beck, D. E. Rider, and B. R. Waterman, “Adding Lateral Retinacular Release to Medial Patellofemoral Ligament Reconstruction Fails to Demonstrate Clinical Benefit Compared With Isolated Medial Patellofemoral Ligament Reconstruction,” Arthroscopy, Sports Medicine, and Rehabilitation 6, no. 2 (2024): 100890, https://doi.org/10.1016/J.ASMR.2024.100890.

[64] N. Kheir, G. Salvatore, A. Berton, et al., “Lateral Release Associated With MPFL Reconstruction in Patients With Acute Patellar Dislocation,” BMC Musculoskeletal Disorders 23 (2022): 139, https://doi.org/10.1186/S12891-022-05013-5.

[65] P. Su, X. Liu, N. Jian, J. Li, and W. Fu, “Clinical Outcomes and Predictive Factors for Failure With MPFL Reconstruction Combined With Tibial Tubercle Osteotomy and Lateral Retinacular Release for Recurrent Patellar Instability,” BMC Musculoskeletal Disorders 22 (2021): 1-9, https://doi.org/10.1186/S12891-021-04508-X.

[66] B. Unal, B. B. Hinckel, S. L. Sherman, and C. Lattermann, “Comparison of Lateral Retinaculum Release and Lengthening in the Treatment of Patellofemoral Disorders,” American Journal of Orthopedics (Belle Mead, N.J.) 46 (2017): 224-228.

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