Table 1.

Main Steps of MPFL Reconstruction Technique With Pedicled Quadriceps Tendon Graft

1. Diagnostic arthroscopy is performed to rule out intra-articular injuries.

2. Exposure of the quadriceps tendon is performed with a skin incision length of 4 to 5 cm.

3. A superficial vertical incision is made 2 to 3 cm superior to the proximal patellar pole.

4. Harvesting of the superficial layer of the quadriceps tendon with a length of 9 cm is performed.

5. The pedicled graft is reflected 180° and rotated 90° toward medial.

6. The interval between the capsule and the vastus medialis obliquus is developed to the femoral insertion of the MPFL.

7. The graft is pulled between the second and third medial layers to the femoral insertion point.

8. The anatomic femoral insertion distal to the femoral physis is identified by fluoroscopy on a true lateral view of the knee for anatomic placement of the graft.

9. The guide pin is drilled to the anterolateral condyle to avoid the neurovascular structures of the popliteal groove or popliteal fossa.

10. A blind-ending tunnel is drilled into the medial femur along the guidewire.

11. The knee is cycled several times from full flexion to full extension with the graft under tension, thus pre-stretching the graft.

12. The graft is secured within the medial condyle with the knee flexed to 30°.