“…4,16,49 Knees with anatomic anomalies such as patella alta, trochlear dysplasia, quadriceps dysplasia, patellar tilt, and anterior tibial tubercle lateralization have a reported high association with symptomatic patellar instability when compared with control knees 11 and may also have altered ME and ATT anatomy as suggested by Servien et al 34 Recent studies 16,31 reported great anatomic variability of the ATT position assessed with computed tomography (CT) scans. Likewise, Sanchis-Alfonso et al 31 argued against the use of radiographic methods, as they do not account for anatomic variations in medial knee anatomy, particularly the ATT, thereby reflecting an added risk for malposition. Although variability in the ATT position was also observed in this study, its distance relative to the MPFL attachment was fairly consistent, averaging 7.9 6 1.2 mm.…”