Allograft Medial Patellofemoral Ligament Reconstruction Using Patellar Suture Anchors and Stepwise Medial Imbrication.

Patellar instability commonly affects adolescents and young athletes and is associated with injury to the medial patellofemoral ligament (MPFL). MPFL reconstruction is a well-established treatment for recurrent instability; however, complications related to graft tensioning, fixation, and incomplete restoration of medial soft-tissue restraints persist. We describe a surgical technique for allograft MPFL reconstruction that emphasizes stepwise imbrication of the medial knee layers, anatomic femoral tunnel placement, and all-suture fixation to the patella. This approach restores both the static restraint provided by the MPFL graft and the dynamic stabilizing effect of the medial soft tissues, creating a "bumper effect" analogous to principles of shoulder stabilization. This technique provides a thoughtful and durable method for MPFL reconstruction and may be performed as an isolated procedure or in conjunction with adjunctive bony or cartilage procedures.