Reconstruction of the Medial Patellofemoral Ligament With Gracilis Tendon Autograft in Transverse Patellar Drill Holes

Purpose: We present clinical results in a case series of 44 patients with medial patellofemoral ligament (MPFL) reconstruction with 12 to 32 months’ follow-up. Methods: Reconstruction was performed via gracilis tendon autograft looped through 2 transverse 4.5-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. At follow-up, Kujala scores, Knee Injury and Osteoarthritis Outcome Scores, objective knee function, complications, and reoperations were assessed. Results: Only 1 patella redislocation was observed. Subluxation occurred in 3 patients, whereas 4 patients had chronic pain at follow-up, all of whom had cartilage injury at surgery. The Kujala knee function score improved overall from 46 points (range, 12 to 67 points) to 84 points (range, 62 to 100 points) at follow-up. Conclusions: MPFL reconstruction with double transverse patella drill holes and a gracilis tendon graft provides good postoperative patellar stability. Postoperative pain seems to be related to the degree of patellofemoral injury found at surgery. Level of Evidence: Level IV, therapeutic case series.

Key Words: Medial patellofemoral ligament, Patellar instability, Ligament reconstruction