1. Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation 
Michael G. Saper, D.O., David A. Shneider, M.D. 
Arthroscopy Techniques 
Volume 3, Issue 2, Pages e227-e231 (April 2014)
DOI: /j.eats
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
View of left knee after midline skin incision, and harvesting of semitendinosus tendon. One-centimeter incisions are made with a knife at the medial and lateral borders of the quadriceps tendon just at the superior edge of the patella.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
A subfascial tunnel is created on the lateral side with a clamp from the quadriceps to the LPFL attachment site at the lateral epicondyle. The same technique is performed on the medial side to form a tunnel between the quadriceps and MPFL attachment site.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
With a No. 11 blade scalpel, a transverse tunnel is made in the distal quadriceps beneath the anterior lamina of the quadriceps tendon, just superior to the patella.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
The medial end of the graft is secured with a No. 2 suture. The graft is then passed through the quadriceps and the medial subfascial tunnel to the MPFL attachment site.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
The medial side is fixed in the MPFL attachment site on the femur with a knotless anchor (not shown). After measurement of the correct length for the tendon at the lateral epicondyle, the excess tendon is cut off. The end of the tendon is secured with a No. 2 loop suture. The graft is then passed through the lateral subfascial tunnel to the LPFL attachment at the lateral epicondyle.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
The lateral side is fixed at the LPFL attachment site on the lateral femoral epicondyle with another knotless anchor.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
(A) Preoperative arthroscopic image of patellofemoral compartment (left knee) viewed from lateral portal showing lateral patellar subluxation with medial patellar laxity and femoral trochlea dysplasia. (B) Postoperative arthroscopic image of patellofemoral articulation, viewed from lateral portal (left knee), showing stable patella, centered in trochlea.
Arthroscopy Techniques 2014 3, e227-e231DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions