Table 1.

Key Points to Modified Reverse-Loop MPFL Reconstruction Technique

Perform a preoperative examination under anesthesia of lateral patellar glide, allowing for a direct comparison after provisional fixation.

Use a Kirschner wire and fluoroscopy to confirm placement of the femoral tunnel before drilling.

Remain extracapsular, carefully dissecting between retinacular layers 2 and 3.

Ensure that each limb of the allograft tendon is at least 6 cm long, and mark the midpoint to identify the femoral fixation site.

Place the femoral anchor (Super QuickAnchor Plus DS), and secure the graft in this location before addressing the patella.

During patellar anchor (Super QuickAnchor Plus DS) preparation, cut and remove one of the 2 No. 2 sutures (Fig 4A), pass a suture threader (ConMed Linvatec) through the eyelet of the anchor (Fig 4B), place the looped end of the suture within the loop of the suture threader (Fig 4C), and then pull the threader back through the anchor eyelet (Figs 4D and 4E).

Center the patellar anchors within the proximal two-thirds of the patella.

While provisionally tensioning the graft, maintain the knee at 30° of flexion by placing a towel bump under the knee.

Use appropriate tension to remove any graft redundancy at 30°, maintain the patella centered within the trochlea from 0° to 30°, and allow for mild graft laxity in hyperflexion.

Evaluate patellofemoral tracking arthroscopically before definitive graft fixation.

During closure, imbricate retinacular layers 1 and 2 to match the resting tone of the reconstructed ligament and then assess lateral patellar glide once more to ensure that over-tensioning has not occurred.