Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective pilot study

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis. Results A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

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Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective study

10.21203/rs.3.rs-327972/v1 ◽

2021 ◽

Author(s):

Xiangtian Deng ◽

Lingzhi Li ◽

Peng Zhou ◽

Yuan Li ◽

Yanwei He ◽

...

Keyword(s):

Clinical Outcomes ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Genu Valgum ◽

Mpfl Reconstruction ◽

Ct Scans ◽

Recurrent Patellar Dislocation ◽

Derotation Osteotomy ◽

The Mean

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29) years) with RPD with increased FAA and genu valgum who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA. Results A total of 13 patients (13 knees) were included with an average follow-up period of 14.7 months (range 12–26). No cases of patients developed wound infection, soft tissue irritation, and recurrent dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, ICDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA changed significantly from 82.72°±3.27° to 88.63°±2.35°. The mean TT-TG distance significantly decreased from 19.63 ± 3.21 mm to 13.29 ± 2.78 mm, while the CDI did not change significantly after surgery (p༞0.05). The mean FAA significantly decreased from 32.77°±3.78° to 19.08°±3.14°, while the tibial torsion did not change significantly after surgery (p༞0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

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Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119900373 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596711990037

Author(s):

Hangzhou Zhang ◽

Mao Ye ◽

Qingwei Liang

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Case Series ◽

Mpfl Reconstruction ◽

Suture Fixation ◽

Recurrent Patellar Dislocation ◽

Patellar Tilt ◽

Transosseous Suture ◽

Patellar Tilt Angle

Background: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. Purpose: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. Results: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 ( P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to –3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively ( P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. Conclusion: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

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Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

The American Journal of Sports Medicine ◽

10.1177/03635465211037716 ◽

2021 ◽

pp. 036354652110377

Author(s):

Jong-Min Kim ◽

Jae-Ang Sim ◽

HongYeol Yang ◽

Young-Mo Kim ◽

Joon-Ho Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Tibial Tuberosity ◽

Mpfl Reconstruction ◽

Trochlear Groove ◽

Functional Failure ◽

Radiological Parameters ◽

Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

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Medial Patellofemoral Ligament (MPFL) Reconstruction Surgery in Iranian Patients with Recurrent Patellar Dislocation: Report of Three Years Experiences

Biomedical & Pharmacology Journal ◽

10.13005/bpj/595 ◽

2015 ◽

Vol 8 (1) ◽

pp. 165-170 ◽

Cited By ~ 1

Author(s):

Ali Torkaman ◽

Siamak Monshizadeh ◽

Mohammadhasan Shabanpour

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Mpfl Reconstruction ◽

Recurrent Patellar Dislocation ◽

Reconstruction Surgery ◽

Iranian Patients

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Closing-Wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

10.21203/rs.3.rs-38833/v1 ◽

2020 ◽

Author(s):

Lizhong Jing ◽

Xiaole Wang ◽

Kun Liu ◽

Xiaotan Wang ◽

Lu Jiang ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Weight Bearing ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Imaging Findings ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy

Abstract Background: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, for RPD with genu valgum, simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO) may be a promising procedure yet rarely reported. This study’s purpose was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.Methods: From May 2015 to Apirl 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the femorotibial angle (FTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results: 25 patients, with an average age of 19.8 years (14–27), were evaluated. All patients had been able to achieve a better sports level without any problems during the 2-year follow-up period. There has been no recurrence of patellar instability. Compared with preoperation, the FTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance was found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant improvement postoperatively.Conclusions: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, as it leads to significant improvement in the clinical and imaging findings of the knee in the short term.

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Closing-wedge distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation with genu valgum

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04554-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lizhong Jing ◽

Xiaole Wang ◽

Xiaoliang Qu ◽

Kun Liu ◽

Xiaotan Wang ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Weight Bearing ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Imaging Findings ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy

Abstract Background Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum. Methods From May 2015 to April 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the anatomical femorotibial angle (aFTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively. Results 25 patients, with an average age of 19.8 years (14–27), were evaluated. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement. Conclusions CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.

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Surgical Treatment With Closing-Wedge Distal Femoral Osteotomy for Recurrent Patellar Dislocation With Genu Valgum

The American Journal of Sports Medicine ◽

10.1177/0363546518765479 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1632-1640 ◽

Cited By ~ 9

Author(s):

Kyung Wook Nha ◽

Yoonwon Ha ◽

Seungmin Oh ◽

Vivek P. Nikumbha ◽

Sae Kwang Kwon ◽

...

Keyword(s):

Surgical Treatment ◽

Patellar Dislocation ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Lateral Release ◽

Trochlear Groove ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy ◽

The Mean

Background: Closing-wedge distal femoral osteotomy (CWDFO)—combined with medial reefing and lateral release, if necessary— has been used to treat recurrent patellar dislocation (RPD) with genu valgum. Purpose: To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum. Study Design: Case series; Level of evidence, 4. Methods: Fourteen consecutive patients (23 knees) with RPD and genu valgum were treated with CWDFO. Patients with a minimum 2-year follow-up period were eligible for this study. Patients with prior failed surgery were also eligible. Radiographic evaluation was performed with mechanical femorotibial and lateral distal femoral angle. The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPD were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes (eg, occurrence of redislocation, range of motion, and clinical scores) were assessed pre- and postoperatively at a minimum of 2 years. Results: At a mean follow-up of 30.7 months (range, 25-62 months), the mean mechanical femorotibial and mechanical lateral distal femoral angles changed significantly from valgus 5° (range, 2°-11°) to varus 3° (2°-11°; P < .001) and from 83° (range, 78°-86°) to 89° (84°-92°; P < .001), respectively. The mean patellar congruence angle improved from 40° lateral (range, 20°-53° lateral) to 4° medial (23° medial to 21° lateral; P < .001), as did the lateral patellofemoral angle from 26° (range, 8°-62°) to 9° (0°-15°; P < .001). Computed tomography scans showed that the mean distance of patellar lateral shift decreased from 13.5 mm (range, 4-22 mm) to 2.0 mm (–4 to 5 mm; P < .001). The mean tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm ( P < .001), while the Caton-Deschamps ratio did not change significantly after surgery ( P = .984). Chondral lesions of the patella and trochlear groove significantly improved or were maintained. None of the patients experienced subluxation or redislocation after surgery. Patellar instability symptoms also improved, as validated by radiographic and other clinical outcomes. Conclusion: CWDFO combined with medial reefing and lateral release successfully treated RPD with genu valgum for a minimum follow-up of 2 years, with improved patellar alignment and stability.

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Medial patellofemoral ligament reconstruction using autologous hamstring graft for recurrent patellar dislocation: a clinical and functional outcome evaluation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212436 ◽

2021 ◽

Vol 7 (4) ◽

pp. 854

Author(s):

Sanjib Ghosh ◽

Ayon Das ◽

Mahak Baid ◽

Arijit Das

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Patellofemoral Instability ◽

Outcome Evaluation ◽

Mpfl Reconstruction ◽

Anatomical Reconstruction ◽

Complication Rates ◽

Hamstring Graft ◽

Recurrent Patellar Dislocation ◽

Kujala Score

<p>Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. Surgical treatment for patellar dislocation has evolved from the initial medial reefing to the present-day anatomical reconstruction of medial patellofemoral ligament (MPFL) which is thought to be the most appropriate treatment. MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient most important static primary soft tissue restraint. This prospective case series was conducted at a Tertiary care Govt. Hospital in Kolkata between January 2019 to August 2020 on 15 patients who underwent MPFL reconstruction for recurrent patellar dislocation. All patients were followed up at an interval of 2 weeks, 6 weeks, 3 months and 6 months. Kujala score was used to assess the functional outcomes of the patients. Out of 15 patients, 13 (86.7%) showed good to excellent results whereas 2 (13.3%) had Fair outcome and none of the patients demonstrated Poor surgical result. The mean Kujala score improved from 49.6 pre-operatively to 92.7 post-operatively. By the end of 6 months follow-up, 13 (86.7%) patients achieved almost full range of motion. Majority (80%) of patients did not have any complications. Only 2 patients had a post-operative recurrence (13.3%). Reconstruction of MPFL using autologous hamstring graft showed excellent results over the short term with a low re-dislocation rate and acceptable complication rates. It greatly helps in preventing further episodes of patellar subluxations or dislocations and in improving quality of life.</p>

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Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

10.21203/rs.3.rs-38833/v2 ◽

2020 ◽

Author(s):

Lizhong Jing ◽

Xiaole Wang ◽

Kun Liu ◽

Xiaotan Wang ◽

Lu Jiang ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Weight Bearing ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Imaging Findings ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy

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Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation

The American Journal of Sports Medicine ◽

10.1177/0363546509333482 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1735-1742 ◽

Cited By ~ 107

Author(s):

Mario Ronga ◽

Francesco Oliva ◽

Umile Giuseppe Longo ◽

Vittorino Testa ◽

Giovanni Capasso ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Case Series ◽

Predisposing Factors ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Level Of Evidence ◽

The Mean

Background Several medial patellofemoral ligament reconstruction procedures have been proposed to manage recurrent patellar dislocation. Hypothesis Reconstruction of the medial patellofemoral ligament using a hamstring graft with a 2 transverse patellar tunnels technique is an effective treatment for recurrent patellar dislocation in patients without any evident predisposing factors. Study Design Case series; Level of evidence, 4. Methods Twenty-eight patients with chronic patellar instability without any anatomic predisposing factors, experiencing recurrent unilateral patellar dislocation, were included in the study. Evaluation included the modified Cincinnati and the Kujala scores, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score increased from 52 preoperatively to 89 (P = .001). The mean Kujala scores increased from 45 preoperatively to 83 (P = .03). The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than the nonoperated limb (P = .04). The mean Insall-Salvati index was 1.1 (range, 0.9-1.2) preoperatively and remained within normal range (1.1 [range, 0.9 to 1.2]) (P = .07), at latest follow-up. Significant isokinetic strength differences were found between the operated and the contralateral limbs (.05 < P < .006), even at the latest follow-up. Three patients experienced a new patellar dislocation. Conclusion Medial patellofemoral ligament reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.

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