Combined reconstruction of the medial patellotibial and patellofemoral ligaments

Background. Patellofemoral instability is commonly associated with the rupture of the medial patellofemoral ligament (MPFL), and the role of the medial patellotibial ligament (MPTL) is slowly emerging. Soft tissue reconstructions are able to restore patellar stability. Methods. We present a surgical technique for the combined reconstruction of the MPFL and MPTL using gracilis or semitendinosus tendon (ST) autograft and two patellar tunnels, looping the free end of the tendon graft around the adductor magnus tendon. Results. In this surgical technique the femoral physeal plate is not affected, no femoral tunnel needs to be drilled, no hardware is needed to fix the graft to the bone. Conclusion. The technique described is simple, safe, inexpensive, reproducible and does not require intraoperative fluoroscopy.