Abstract
Many techniques have been described for the reconstruction of the medial patellofemoral ligament (MPFL) in patients with acute or recurrent instability. Most commonly, an MPFL hamstring tendon auto- or allograft is used, attached to the patella and medial femoral condyle using bone tunnels and various fixation implants to ensure stable fixation and graft healing. We describe a surgical technique in which an MPFL semitendinosus graft is inserted in a partial-width transverse patellar bone tunnel (typically 6-6.5 mm in diameter and 15-20 mm in length) and stabilized using adjustable loop cortical button fixation. In the femur, a tunnel is drilled in an oblique superolateral direction (typically 6-6.5 mm in diameter and 30 mm in length), and the graft is inserted and stabilized using an absorbable interference screw. The graft is tightened at 60° of knee flexion and retensioned after knee cycling as necessary, with the adjustable loop button. The described technique affords sufficient initial graft fixation strength, thereby eliminating the need for postoperative immobilization.