Medial Patellofemoral Ligament Reconstruction With a Looped Semitendinosus Tendon, Using Knotless Anchor Fixation on the Patella and Hybrid Fixation on the Femur  Alexander Golant, M.D., Tony Quach, M.D., Jeffrey E. Rosen, M.D.  Arthroscopy Techniques  Volume 3, Issue 2, Pages e211-e216 (April 2014) DOI: 10.1016/j.eats.2013.10.001 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Guidewires are drilled into the medial facet of the patella, where the 2 free limbs of the graft will be secured. One should note the incision over the pes anserinus for harvesting of the semitendinosus tendon. (B) Fluoroscopic verification of appropriate guidewire position on anteroposterior image. Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 The free limbs of the semitendinosus graft have been secured into the 4.5-mm sockets on the proximal half of the medial patellar facet with 2 Arthrex 4.75-mm SwiveLock anchors. One should note that the graft has been preloaded onto an adjustable-loop suspensory cortical button device (Biomet ToggleLoc). Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 The location for the femoral insertion of the MPFL is identified with the aid of fluoroscopy and a radiodense template, and a guidewire is drilled into this spot. Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 The femoral guidewire is over-reamed with a reamer (the diameter of which matches the diameter of the graft) as far as possible across the distal femur, without violating the medial cortex. Ideally, the reamer should be stopped within 2 cm from the medial cortex. Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 5 The graft, along with the ToggleLoc device, has been tunneled within the second layer of the medial knee (deep to the crural fascia, superficial to the medial retinaculum) to the opening of the femoral tunnel. Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 6 (A) Fluoroscopic anteroposterior image of final reconstruction. One should note that the button is lying directly on the medial cortex. In addition, the central position of the patella should be noted. (B) Fluoroscopic lateral image of final reconstruction. One should note the positions of the patellar and femoral tunnels, consistent with the anatomic insertions of the native MPFL. Arthroscopy Techniques 2014 3, e211-e216DOI: (10.1016/j.eats.2013.10.001) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions