Arthroscopic and Mini-Open Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction for J-Sign-Positive Patellar Dislocation.

Abstract

This technical note addresses recurrent patellar instability with a positive J-sign and describes a minimally invasive, arthroscopic and mini-open approach that combines medial patellofemoral ligament and medial patellotibial ligament reconstruction with extensive lateral retinacular release, positioned as a preferred or transitional option before bony procedures. The strategy emphasizes functional localization and tension modulation. Compared with imaging threshold-driven osteotomies, this approach is less invasive, cosmetically favorable, individually adjustable, and supports rapid rehabilitation. It can serve as definitive treatment for skeletally immature patients or those with low-grade J-sign, and for high-grade J-sign it may reduce reliance on osteotomy while preserving a clear pathway for salvage if needed.