Surgical Techniques to Address Patellofemoral Instability: An Individualized Approach

Patellar instability involves complex decision making and an individualized approach. Often, patients with high-risk pathoanatomic features present after a single or recurrent dislocation events. Consideration of the patient's osseous anatomy, age, dynamic examination findings, evaluation of soft-tissue tension, dislocation history, and goals are all integral to the treatment plan. With regards to surgical intervention, medial patellofemoral ligament reconstruction is the most commonly performed procedure to provide static stability to the patella. Concomitant proximal and distal realignment procedures can be performed, but consensus is lacking for whom these may be necessary. This Technique Note describes the order of operations and the author's preferred technique for performing a medial patellofemoral ligament reconstruction using hamstring autograft concurrently with lateral retinacular lengthening, vastus medialis oblique advancement, native medial patellofemoral ligament imbrication, and tibial tubercle osteotomy or patellar tendon shortening through 2 main incisions, for a patient with high-risk pathoanatomic features and examination.