Medial Patellofemoral Ligament Reconstruction: A Non-implant Technique

Medial patellofemoral ligament (MPFL) reconstruction is a widely performed procedure for patellofemoral instability. However, there is no consensus on the optimal graft choice, fixation method, or surgical technique. Most described techniques require implants such as anchors or interference screws, which increase stiffness and cost. In many developing countries, the high cost of implants limits access to surgery. We describe a reproducible, effective, and low-cost MPFL reconstruction technique that avoids implants, using a semitendinosus autograft, a modified Fithian technique for patellar fixation, and an adductor tendon loop ("adductor sling") for femoral fixation. The technique was developed to minimize complications related to implant use and reduce costs, while maintaining anatomical graft placement and dynamic stability assessment. This implant-free MPFL reconstruction technique offers a safe and affordable surgical option for the management of patellofemoral instability, particularly in resource-limited settings. Socioeconomic factors should be considered when selecting a reconstruction method.