Combined Reconstruction of the Medial Patellofemoral Ligament and the Medial Quadriceps Tendon-Femoral Ligament Using Rectus Femoris Tendon Autograft.

Patellofemoral instability remains a challenging condition, especially in skeletally immature patients, who are at increased risk of recurrence. The medial patellofemoral ligament has historically been the focus of surgical reconstruction; however, recent anatomic studies have also highlighted the medial quadriceps tendon-femoral ligament as part of the medial patellofemoral complex, a key stabilizer during early knee flexion. Recognition of the medial patellofemoral complex has prompted a shift toward combined reconstruction techniques that more accurately replicate native anatomy. The rectus femoris tendon autograft, recently applied in anterior cruciate ligament surgery, offers unique advantages owing to its preserved patellar attachment. In this Technical Note, we describe an anatomic V-shaped reconstruction of the medial patellofemoral complex, combining both medial patellofemoral ligament and the medial quadriceps tendon-femoral ligament with a rectus femoris autograft, providing a biomechanically rational approach that restores physiologic stability while minimizing the risk of patellar fracture.