Double-Bundle Medial Patellofemoral Ligament Reconstruction Using Free Rectus Femoris Autograft

The rectus femoris tendon autograft represents a relatively new graft option, primarily used in anterior cruciate ligament revision surgery. In this technical note, we describe a technique for medial patellofemoral ligament reconstruction using a double-bundle rectus femoris autograft. This approach combines the favorable biomechanical characteristics of the rectus femoris tendon-providing greater tensile strength and load-to-failure capacity than hamstring autografts-with the anatomical precision of a free graft reconstruction. Unlike the classical quadriceps tendon medial patellofemoral ligament technique, which preserves the native quadriceps insertion at the superior pole of the patella and thus deviates from true medial patellofemoral ligament anatomy, our method allows an anatomic patellar fixation.