Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: Technical note and preliminary results

Purpose: Various techniques for reconstruction of the medial patellofemoral ligament (MPFL) have been developed. In this article, a modified technique for anatomical two-bundle MPFL reconstruction with hardware-free patellar graft fixation is described and the preliminary results of this technique are presented. Methods: A modified surgical technique for MPFL reconstruction with a gracilis tendon autograft and hardware-free patellar graft fixation using two short oblique bone tunnels is described in detail. Complications and preliminary results of this procedure were assessed in 19 patients at a mean follow-up of 16 ± 3 months using the Kujala score, Tegner scale, and Insall score. Results: No postoperative patellar dislocation or subluxation was reported. Eighty-nine per cent of the patients were either satisfied or very satisfied with the overall outcome. The mean Kujala score was 92 ± 7 (range 69-100), and the median Tegner scale was 5 (range 3-7). According to the Insall score, the results of 18 patients (95 %) were rated as good or excellent. Postoperative complications occurred in 3 patients (16 %), with two of them persisting only temporary. Conclusions: The described technique for anatomical two-bundle MPFL reconstruction is a safe and effective surgical procedure for the treatment of lateral patellar instability, with several methodical advantages compared to similar techniques. Further evaluation in a larger patient cohort with a longer follow-up is necessary to confirm these short-term results. Level of evidence: IV.