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Xu Z, Huang S, Song Y, Xu C, Yan H, Linkun O, Lv B, Yuan F, Xu B, Wang H, Xi R, Yu JK. Identification of eight genes associated with recurrent patellar dislocation. iScience 2024; 27:109697. [PMID: 38680665 PMCID: PMC11046295 DOI: 10.1016/j.isci.2024.109697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/05/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024] Open
Abstract
The inheritance of recurrent patellar dislocation (RPD) is known, but the susceptible gene remains unidentified. Here, we performed the first whole exome sequencing (WES) cohort study to identify the susceptible genes. The results showed eight genes were associated with this disease. Notably, the carboxypeptidase D (CPD) gene showed the highest relevance based on its gene function and tissue expression. Single-cell sequencing results indicate that the CPD gene is involved in the pathophysiological process of RPD through granulocytes. Implicated pathways include nuclear factor kappa B (NF-κB), mitogen-activated protein kinase (MAPK), and Wnt/β-catenin signaling, potentially influencing CPD's role in RPD pathogenesis. This study identified the susceptible gene and investigates the potential pathogenesis of RPD, which provided a new prospect for the understanding of RPD. Besides, it would offer the theoretical basis for disease prevention and genetic counseling.
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Affiliation(s)
- Zijie Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Siyuan Huang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yifan Song
- Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Beijing, China
| | - Chao Xu
- The Department of Joint Surgery and Sports Medicine, The Second Affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Hongyu Yan
- Department of Pediatric Neurology, Children’s Hospital Affiliated to the Capital Institute of Pediatrics, Peking University, Beijing, China
| | - Ouyang Linkun
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Bo Lv
- Department of Orthopedics, People’s Hospital of Guilin, Guilin, Guangxi, China
| | - Fuzhen Yuan
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Bingbing Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Haijun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Ruibin Xi
- School of Mathematical Sciences and Center for Statistical Science, Peking University, Beijing, China
| | - Jia-Kuo Yu
- Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Beijing, China
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Chang K, Albright JA, Quinn M, Khatri S, Zhao L, Byrne RA, Daniels AH, Owens BD. A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization. Sports Health 2024; 16:465-472. [PMID: 37208906 PMCID: PMC11025508 DOI: 10.1177/19417381231172726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Vitamin D has been proven experimentally to affect musculoskeletal health. The purpose of this study was to identify the relationship between vitamin D deficiency and patellar instability. HYPOTHESIS Vitamin D deficiency is associated with an increased risk of experiencing primary patellar instability and recurrent patellar dislocation after primary surgical stabilization. STUDY DESIGN Retrospective comparative study. LEVEL OF EVIDENCE Level 3. METHODS A 1:1 matched retrospective study of 328,011 patients diagnosed with vitamin D deficiency was performed using the PearlDiver database. Incidence of primary patellar instability was calculated according to sex and age. Rates of primary patellar instability and surgical stabilization for recurrent dislocation were calculated with sex- and age-specific stratifications. Multivariable logistic regression was used to compare the rates of primary injury and recurrent stabilization while controlling for demographics and medical comorbidities. RESULTS A total of 656,022 patients were analyzed. The overall 1-year incidence rate of patellar instability in patients with vitamin D deficiency was 82.6 per 100,000 person-years (95% CI, 73.2-92.9), compared with 48.5 (95% CI, 41.4-56.5) in the matched control. Women were significantly more likely to experience primary patellar instability within 1 (adjusted odds ratio [aOR] = 1.45; 95% CI, 1.12-1.88) and 2 years (aOR, 1.31; 95% CI, 1.07-1.59) of hypovitaminosis D diagnosis. Patients aged 10 to 25 years with hypovitaminosis D were at greater risk of requiring recurrent patellar stabilization for both men (aOR, 2.48; 95% CI, 1.06-5.80) and women (aOR, 1.77; 95% CI, 1.04-3.02). CONCLUSION Patients diagnosed with vitamin D deficiency experienced higher rates of primary patellar instability and have greater risk of requiring recurrent surgical stabilization for subsequent dislocations. CLINICAL RELEVANCE These results suggest that monitoring and proactively treating vitamin D deficiency in the physically active patient may lower the risk of suffering primary patellar instability or recurrence after surgical stabilization.
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Affiliation(s)
- Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - J. Alex Albright
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Quinn
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Surya Khatri
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leon Zhao
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rory A. Byrne
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Alan H. Daniels
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Brett D. Owens
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
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Camanho GL, Gobbi RG, Helito CP, Moreira da Silva AG, Machado de Oliveira G. Medial Patellofemoral Ligament Reconstruction Using the Medial Third of the Patellar Tendon: Camanho's Technique. Arthrosc Tech 2024; 13:102913. [PMID: 38690355 PMCID: PMC11056719 DOI: 10.1016/j.eats.2024.102913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/08/2023] [Indexed: 05/02/2024] Open
Abstract
The reconstruction of the medial patellofemoral ligament (MPFL) is an essential procedure in the surgical treatment of patellar instability. The medial third of the patellar tendon is a good graft option for this reconstruction, maintaining the insertion of the graft in the patella, with no need for hardware for patellar fixation. The objective of this article is to describe the MPFL reconstruction technique with the patellar tendon graft.
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Affiliation(s)
- Gilberto Luis Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriel Machado de Oliveira
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Dai R, Wu Y, Jiang Y, Huang H, Meng Q, Shi W, Ren S, Ao Y. Epidemiology of Lateral Patellar Dislocation Including Bone Bruise Incidence: Five Years of Data from a Trauma Center. Orthop Surg 2024; 16:437-443. [PMID: 38214094 PMCID: PMC10834195 DOI: 10.1111/os.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Systematic summary of the epidemiology of patellar dislocation is rare. This study aims to investigate sex-, age-, type-, injury causing events-, incidence of bone bruise and time from last injury (TFLI)-specific characteristics, and detail the epidemiological characteristics of patellar dislocation. METHOD In this descriptive epidemiological study, a total of 743 patients who have a history of lateral patellar dislocation with either first-time patellar dislocation (FPD) or recurrent patellar dislocation (RPD) between August 2017 and June 2022 at our institution met the inclusion criteria and were selected in this study. Patient characteristics including the type, gender, age, events leading to patellar dislocation, incidence of patellar bone bruise, and the time from last injury (TFLI) of patellar dislocation were retrospectively obtained and described. Magnetic resonance imaging scans (MRI) of the knee were reviewed for insuring bone bruise. RESULTS Among the 743 patients with patellar dislocation who required surgical reconstruction of the medial retinaculum, 418 (56.2%) had RPD and 325 (43.8%) had FPD. There were more females (65.0%) than males (35.0%) in patellar dislocation patients. Among the female patients, those aged <18 years had higher incidence (31.4%) of patellar dislocation. Among the male patients, those aged <18 and 19-28 years had higher incidence (16.8%) of patellar dislocation. Of all age groups, the prevalence rate of patellar dislocation was high in juvenile population and females, but with no statistical significance. The most common patellar dislocation-causing event was sport accidents (40.1%), followed by life accidents (23.2%). The incidence of left-knee patellar dislocation was slightly higher than that of right-knee patellar dislocation. The incidence of patellar bone bruise of RPD (63.2%) was significantly lower (p < 0.05) than that of FPD (82.2%). Patellar dislocation patients with bone bruise had shorter time from last injury (TFLI) than those without patellar bone bruise (p < 0.05). CONCLUSIONS The incidence of bone bruise of RPD was lower than that of FPD, and patients with patellar bone bruise may have a shorter time from last injury than those without bone bruise.
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Affiliation(s)
- Ruilan Dai
- College of Exercise and health Sciences, Tianjin University of SportTianjinChina
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yue Wu
- College of Exercise and health Sciences, Tianjin University of SportTianjinChina
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yanfang Jiang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Hongshi Huang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Qingyang Meng
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Weili Shi
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Shuang Ren
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yingfang Ao
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
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Eysturoy NH, Husum HC, Mortensen ES, Blønd L, Hölmich P, Barfod KW. High prevalence of patellar dislocation and trochlear dysplasia in a geographically and genetically isolated society: an observational national cohort study from the Faroese Knee Cohort. Acta Orthop 2024; 95:14-19. [PMID: 38240376 PMCID: PMC10798052 DOI: 10.2340/17453674.2024.35229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to calculate the prevalence of patellar dislocation (PD) and trochlear dysplasia (TD) in a national cohort aged 15-19 years in the Faroe Island. PATIENTS AND METHODS All inhabitants in the Faroe Islands aged 15-19 years were invited to answer an online survey, including demographics and questions regarding prior PD. Participants with prior PD were invited for radiographs and MRI of both knees to be taken. Trochlear dysplasia was defined as one of the following: Dejour type A-D on radiographs, lateral trochlear inclination angle (LTI) < 11°, or trochlear depth < 3 mm on MRI. RESULTS 3,749 individuals were contacted, 41 were excluded, and 1,638 (44%) completed the survey. 146 reported a prior PD (the PD cohort) and 100 accepted to participate and have radiographs and MRI taken of both knees (the clinical PD cohort), 76 of whom were diagnosed with TD. The national prevalence of PD was 8.9%. The national prevalence of symptomatic TD was 6.8%. The prevalence of TD in the clinical PD cohort was 76%. TD was bilateral in 78% of TD patients, but only 27% of patients with bilateral TD had PD in both knees. CONCLUSION The prevalence of PD in the Faroe Islands is found to be very high. The national prevalence of TD and the prevalence of TD in participants with prior PD is high, indicating a potential genetic influence.
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Affiliation(s)
- Niclas H Eysturoy
- Department of Orthopedic Surgery, National Hospital of the Faroe Islands, Torshavn, the Faroe Islands.
| | | | - Elinborg S Mortensen
- Department of Orthopedic Surgery, National Hospital of the Faroe Islands, Torshavn, the Faroe Islands
| | - Lars Blønd
- Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen
| | - Kristoffer W Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen
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Gaudiani MA, Castle JP, Pfennig MT, Jawanda HS, Meta F, Lynch TS. Suture Anchor Fixation Has Less Gap Formation and No Difference in Complications or Revisions for Patellar Tendon Repair: A Systematic Review. Arthroscopy 2024; 40:149-161. [PMID: 37230184 DOI: 10.1016/j.arthro.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To evaluate the literature on suture anchor (SA) usage for patellar tendon repair, summarize the overall biomechanical and clinical outcomes, and assess whether the cumulative research supports the adoption of this technique compared with transosseous (TO) repair. METHODS A systematic literature review using the Preferred Reporting Items for Systematic and Meta-Analyses guidelines was performed. Multiple electronic databases were searched to identify studies focusing on surgical outcomes of patellar tendon repair with suture anchor usage. Cadaver and animal biomechanical studies, technical studies, and clinical studies were included. RESULTS A total of 29 studies met the inclusion criteria: 6 cadaver, 3 animal, 9 technical, and 11 clinical reports. Four of the 6 cadaver studies and 1 of the 2 animal studies found significantly less gap formation from SA than from TO repair. Average gap formation in human studies ranged from 0.9 to 4.1 mm in the SA group compared with 2.9 to 10.3 mm in TO groups. Load to failure was significantly stronger in 1 of 5 cadaver studies and 2 of 3 animal studies, with human studies SA load to failure ranging from 258 to 868 N and TO load to failure ranging from 287 to 763 N. There were 11 clinical studies that included 133 knees repaired using SA. Nine studies showed no difference between complication rate or risk for reoperation, where one study reported a significantly lower re-rupture rate after SA repair compared with TO repair. CONCLUSIONS SA repair is a viable option for patellar tendon repair and could have several advantages over TO repair. Multiple studies indicate that SA repair has less gap formation during biomechanical testing compared with TO repair in human cadaver and animal models. No differences in complications or revisions were found in the majority of clinical studies. CLINICAL RELEVANCE Both animal and human models suggest SA fixation has potential biomechanical benefits when compared with TO tunnels for patellar tendon repair, whereas clinical studies show no difference in complications and revisions postoperatively.
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Affiliation(s)
- Michael A Gaudiani
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A..
| | - Joshua P Castle
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Mitchell T Pfennig
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Harkirat S Jawanda
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Fabien Meta
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - T Sean Lynch
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
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Forde C, Costa ML, Cook JA, Tutton E, Appelbe D, Franssen M, Barker R, Keene DJ. Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD)-protocol for an external pilot randomised controlled trial and qualitative study comparing supervised versus self-managed rehabilitation for people after acute patellar dislocation. Pilot Feasibility Stud 2023; 9:119. [PMID: 37430340 DOI: 10.1186/s40814-023-01349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Patellar dislocations mainly affect adolescents and young adults. After this injury, patients are usually referred to physiotherapy for exercise-based rehabilitation. Currently, limited high-quality evidence exists to guide rehabilitation practice and treatment outcomes vary. A full-scale trial comparing different rehabilitation approaches would provide high-quality evidence to inform rehabilitation practice. Whether this full-scale trial is feasible is uncertain: the only previous trial that compared exercise-based programmes in this patient population had high loss to follow-up. This study aims to assess the feasibility of conducting a future full-scale trial comparing the clinical and cost-effectiveness of two different rehabilitation approaches for people with an acute patellar dislocation. METHODS Two-arm parallel external pilot randomised controlled trial and qualitative study. We aim to recruit at least 50 participants aged ≥ 14 years with an acute first-time or recurrent patellar dislocation from at least three English National Health Service hospitals. Participants will be randomised 1:1 to supervised rehabilitation (four to six, one-to-one, physiotherapy sessions of advice and prescription of tailored progressive home exercise over a maximum of 6 months) or self-managed rehabilitation (one physiotherapy session of self-management advice, exercise, and provision of self-management materials). Pilot objectives are (1) willingness to be randomised, (2) recruitment rate, (3) retention, (4) intervention adherence, and (5) intervention and follow-up method acceptability to participants assessed through one-to-one semi-structured interviews (maximum 20 participants). Follow-up data will be collected 3, 6, and 9 months after randomisation. Quantitative pilot and clinical outcomes will be numerically summarised, with 95% confidence intervals generated for the pilot outcomes using Wilson's and exact Poisson methods as appropriate. DISCUSSION This study will assess the feasibility of conducting a full-scale trial comparing supervised versus self-managed rehabilitation for people after acute first-time or recurrent patellar dislocation. This full-scale trial's results would provide high-quality evidence to guide rehabilitation provision for patients with this injury. TRIAL REGISTRATION ISRCTN registry ISRCTN14235231 . Registered on 09 August 2022.
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Affiliation(s)
- Colin Forde
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Duncan Appelbe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marloes Franssen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - David J Keene
- Exeter Medical School, University of Exeter, Exeter, UK
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