Quasi-anatomical Reconstruction of the Medial Patellofemoral Ligament

Several methods of MPFL reconstruction have been described. They vary in terms of graft choice, patellar and femoral fixation and graft tension at the time of fixation. In general, it is thought that a non-anatomical graft tends to over-constrain the patellofemoral (PF) joint. Theoretically, this pressure results in the loss of knee motion and increases PF osteoarthritis (OA). Conversely, in a biomechanical laboratory study using cadaver knees, a non-anatomic femoral attachment point in the adductor tubercle did not alter the pressures in the PF joint in comparison to an anatomic attachment. Then again, controversy persists relative to defining the optimal attachment points for the MPFL graft.
The main objective of this video technique is to show a “quasi-anatomical MPFL reconstruction” using a gracilis tendon autograft intended for patients with chronic lateral patellar instability the authors have been using for more than 10 years.