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Surgical Techniques to Address Patellofemoral Instability: An Individualized Approach.

Lafi S Khalil¹, Nicholas D Cominos², Luke Terrian³

¹Department of Orthopaedic Surgery, Henry Ford Health, Clinton Twp, Michigan, U.S.A.

Arthroscopy Techniques

|November 12, 2025

Summary

This study details a surgical technique for patellar instability, focusing on medial patellofemoral ligament reconstruction combined with other procedures. It addresses complex cases with high-risk pathoanatomic features for improved patellar stability.

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Area of Science:

Orthopedic Surgery
Sports Medicine
Biomechanics

Background:

Patellar instability requires individualized treatment, especially in patients with high-risk pathoanatomic features after dislocation.
Key factors include osseous anatomy, age, dynamic findings, soft-tissue tension, and patient goals.

Purpose of the Study:

To describe a specific surgical technique for medial patellofemoral ligament reconstruction in patients with high-risk patellar instability.
To outline the author's preferred order of operations and concurrent procedures.

Main Methods:

Medial patellofemoral ligament reconstruction using hamstring autograft.
Concurrent procedures: lateral retinacular lengthening, vastus medialis oblique advancement, medial patellofemoral ligament imbrication.
Tibial tubercle osteotomy or patellar tendon shortening through two incisions.

Main Results:

The described technique provides a comprehensive surgical approach for complex patellar instability.
Addresses multiple pathoanatomic features contributing to instability.

Conclusions:

This technique note presents a detailed method for managing high-risk patellar instability.
Offers an individualized surgical strategy combining ligament reconstruction with bony and soft-tissue realignment.