Although the IS showed best reliability, we advise to use the MIS as it showed the second best reliability but is, according to the literature, associated with better validity.

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Purpose To assess the diferent surgical techniques and their outcomes following tibial tubercle transfer (TTT) in patients with patellar maltracking. Methods A systematic search of the literature was performed in PubMed, EMBASE and Cochrane Library. Studies reporting patient-reported outcome measures (PROMs) or clinical outcome following: TTT in patients with patellar maltracking were included. Collected PROMs were Lysholm, Kujala, IKDC score, and VAS pain. Clinical outcome included reported clinical success, patient satisfaction, complications and removal of hardware (ROH). Overall pre-, post-operative and change scores were estimated using random-efects meta-analysis models. Results were reported as overall mean and per transfer direction. Results A total of 26 studies and 761 patients (818 knees, mean age 35 years, mean follow-up 5.0 years) were included. In 73% of the studies, surgery was performed after failed conservative treatment. Transfer direction was anteromedial in 76% of all procedures. Overall Lysholm score improved from 61 to 91, Kujala from 52 to 85, IKDC from 53 to 81, and VAS from 6.2 to 2.5, respectively. Clinical success was reported in 79% of patients, and 80% of patients reported to have satisfactory results. Rates of complications and ROH were 13% and 29%, respectively. Conclusions TTT for management of patellar maltracking can lead to good results with clinically meaningful improvement, an overall clinical success of 79% and overall patient satisfaction of 80% when appreciating the underlying anatomic condition and using appropriate technique. The level of evidence was low, and large-scale prospective, comparative cohort studies with uniform outcome scales are needed to conirm these indings. Level of evidence IV.

We report a case of genu recurvatum following eight-Plate epiphysiodesis and the successful treatment of this complication. A 10-year-old patient underwent epiphysiodesis of the knee with eight-Plates. She was followed up and genu recurvatum developed as a complication. At the 12-month follow-up after epiphysiodesis, the treated knee showed a flexion of 135° and an extension of 35°. Lateral radiograph evaluation showed an extension change of the femur. During reoperation, the eight-Plates were repositioned more posterior, which resulted in successful treatment of the hyperextension. Eight-Plates can lead to (treatable) articular surface angle changes in the sagittal plane.

Background: The purpose of this study was to determine the inter-and intra-observer reliability of the patellotrochlear index (PTI) on magnetic resonance images (MRI) in patients with patellofemoral pain. The correlation between the PTI measured on MRI and the modified Insall-Salvati (MIS) ratio measured on radiographs was also assessed. Methods: The PTI was assessed on MRI images and the MIS ratio on radiographs of 66 knees of 62 patients. Assessment was performed by two orthopaedic surgeons, one orthopaedic surgery registrar, two radiologists and one radiology registrar. Correlation coefficients, standard errors of measurement and limits of agreement were calculated for the PTI. To assess the association between the PTI and the MIS ratio, the Pearson's correlation coefficient was calculated. Results: The PTI showed good interobserver reliability (intraclass correlation coefficient (ICC) 0.79; 95% confidence interval (CI) 0.73-0.85) and excellent intra-observer reliability (ICC 0.90; 95% CI 0.89-0.91). The standard error of measurement was 0.05 and limits of agreement with the mean ± 0.09. A very weak and not significant correlation was found between the PTI and the MIS (r = 0.02; P = 0.77). Conclusions: The PTI showed good interobserver reliability and excellent intra-observer reliability. In order to conclude which measurement method of assessing patellar height is truly the most reliable, future studies should investigate agreement parameters (standard error of measurement, limits of agreement) besides solely correlation coefficients. We found a very weak correlation between the PTI and the MIS which suggests that at least one index has poor validity. Future validity studies on indices to assess patellar height are necessary.