Arthroscopically Assisted Dynamic Medial Patellofemoral Ligament Graft Tensioning With Adaptive Length Using Double-Bundle Technique.

Abstract

This technical note describes a practical, anatomy-based medial patellofemoral ligament reconstruction technique emphasizing individualized, dynamic graft tensioning and independent adjustment of patellar graft arms. By prioritizing femoral fixation first, guided by precise, dynamic anatomical landmarks and arthroscopic verification, the graft achieves optimal isometry and stability throughout the range of motion. The method utilizes a gracilis tendon "V"-shaped graft configuration with oblique patellar tunnels, ensuring symmetrical, independent tensioning of both graft arms. Additionally, intraoperative graft tension adjustments facilitate dynamic patellar realignment within the trochlear groove, accommodating anatomical variability and trochlear shape differences. This approach aims to reduce complications, enhance patellar tracking, and produce consistent outcomes, especially in cases of severe trochlear dysplasia with variable bony anatomy.