Small, Short, Oblique Patellar Tunnels with Looped Graft Versus Suture Anchors for Patellar-Sided Graft Fixation During MPFL Reconstruction: A Study of Over 600 Knees.

Background: There is a paucity of literature comparing clinical outcomes and complications between the use of 2 smaller (3.2 mm), short, oblique patellar tunnels with looped graft for patellar-sided graft fixation during medial patellofemoral ligament reconstruction (MPFLR) and the use of 2 suture anchors. Purpose: To compare clinical outcomes and complications in large series between the use of dual patellar suture anchors and dual, small, short, oblique bone tunnels for patellar-sided graft fixation during MPFLR. Study Design: Retrospective cohort study; Level of evidence, 3. Methods: A retrospective chart review identified all patients at a single academic institution who underwent primary MPFLR between March 2010 and December 2021, with a minimum 2-year follow-up. Operative notes, postoperative clinical follow-up notes, and radiographs were used to ascertain laterality, graft type, surgical technique, concomitant procedures, as well as the incidence of recurrent patellar instability, revision MPFLR, and patellar fracture. The follow-up was limited to a review of the postoperative clinic or emergency department visits, and patients were not contacted at the time of the study. Results: A total of 635 knees were included for final analysis. Patellar-sided graft fixation was achieved with small, short, oblique bone tunnels with looped grafts in 342 knees (53.9%) and suture anchors in 293 knees (46.1%). The small, oblique tunnels and suture anchor techniques both yielded a low incidence of patellar fracture, with rates of 0.3% and 0%, respectively. No significant difference in rates of patellar fracture existed between cohorts ( Conclusion: Two small (3.2 mm), short, oblique patellar tunnels with looped grafts and dual patellar suture anchors are similar in safety and efficacy for achieving patellar-sided graft fixation during MPFLR.