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Updated: Feb 24, 2026
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Tibial Tubercle Osteotomy With Medial Patellofemoral Ligament Reconstruction Utilizing Autograft Hamstring Tendon and
Alec E Winzenried1, Jake Enos1, Anchal Dhawan2
1Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Background:
Recurrent patellar instability is defined as ≥2 dislocation events or recurrence after surgical treatment. Surgical intervention is aimed at correcting pathoanatomic abnormalities. A tibial tubercle osteotomy (TTO) is an intervention that corrects patients with high tibial tuberosity-trochlear groove (TT-TG) distances and/or patella alta as measured by increased Caton-Deschamps index (CDI). Anteromedialization osteotomies improve abnormal TT-TG distances and offload the patellofemoral joint in patients with chondral lesions. Distalization can be utilized to correct patella alta and can be combined with anteromedialization osteotomies. We present a technique for TTO with medial patellofemoral ligament (MPFL) reconstruction (MPFLR) utilizing autograft gracilis tendon and knotless suture anchor fixation.
Indications:
Indications for a TTO with MPFLR include patients with recurrent patellar instability and increased TT-TG distance and/or increased CDI indicative of patella alta.
Technique Description:
Diagnostic arthroscopic examination of the knee is performed to assess chondral lesions of the patellofemoral joint. An anteromedial approach to the tibia is performed. The harvest of the autograft gracilis tendon is completed. TTO is performed based on the results of the preoperative examination and planning. Fixation is provided by two 4.5-mm stainless steel, solid screws in lag-by-technique mode. Two 1.4-mm knotless, all-suture anchors are then placed at the superomedial and midpoint of the patella after the approach. Schottle's point is identified, and a tunnel is drilled for graft placement. The 2 limbs of the graft are passed between layers 2 and 3 after fixation. An interference screw is used for graft fixation within the tunnel. A repeat examination is performed to confirm patellar stability, and the incisions are then closed.
Results:
All-suture, knotless fixation of MPFL grafts has been shown in biomechanical studies to perform as well as knotted and knotless solid suture anchors when compared with overall load to failure and resistance to cyclic creep. The use of autograft hamstring in adolescents undergoing MPFLR shows no difference when compared with allograft.
Discussion/Conclusion:
Utilization of knotless all-suture anchors with autograft hamstring tendon in MPFLR with TTO presents an alternative to surgical fixation in patients with recurrent patellar instability.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
