Medial Patellofemoral and Medial Patellotibial Ligament Reconstruction Using a Docked Rectus Femoris Graft

Recurrent patellar instability may persist after isolated medial patellofemoral ligament reconstruction, particularly in cases with instability beyond early knee flexion. Recent evidence has emphasized the role of the medial patellotibial ligament as a secondary stabilizer contributing to patellofemoral stability at higher degrees of flexion. As a result, combined reconstruction of the medial patellofemoral ligament and medial patellotibial ligament has emerged as a promising strategy to restore more physiologic patellar kinematics. This technical note describes a reproducible technique for combined medial patellofemoral ligament and medial patellotibial ligament reconstruction using a single rectus femoris tendon autograft harvested from the superficial layer of the quadriceps tendon. The technique is soft-tissue-based and physeal-sparing and avoids bone tunnels, making it particularly suitable for skeletally immature patients. The rectus femoris graft provides sufficient length, favorable biomechanical properties, low donor-site morbidity, and satisfactory cosmetic results through a minimally invasive approach.