Purpose: Patellar instability is a common clinical problem affecting a young, active population. A large number of procedures have been described to treat patellar instability. We present the clinical results in a case series of 25 medial patellofemoral ligament reconstructions in 21 patients with up to 30 months follow-up (mean 7.3 months).

Methods: Reconstruction was performed using either the gracilis tendon (6 cases) or semitendinosus tendon (19 cases) autograft. At follow-up the Tegner activity scores, objective knee function, complications and reoperations were assessed.

Results: No patella re-dislocations were observed. Five patients (20%) required a manipulation under anaesthetic but subsequently regained a satisfactory range of motion. Two patients (8%) had post operative complications. One patient developed a post operative infection which required a washout and one patient developed a neuroma related to the hamstring harvest site which was excised. Both subsequently returned to work with a full range of motion. No patients sustained a patellar fracture.

Conclusions: Medial patellofemoral reconstruction with both gracilis and semitendinosus tendon graft using a longitudinal tunnel technique provided good postoperative patellar stability restoring the primary soft tissue restraint to pathological lateral patellar displacement.

Level of evidence: Level IV, therapeutic case series.

Medial patellofemoral ligament (MPFL) reconstruction is an effective procedure to address patellofemoral instability, however there remains no clear consensus on the optimum technique. Variations in patella tunnel and the use of patella fixation devices are reported in the literature, as are the associated complications of patella fracture and hardware irritation. We present the early results using a two tunnel, Endobutton free technique. 24 MPFL reconstructions (14 female, 10 male) were performed by a single surgeon, using two 3.5mm medial patellar tunnels exiting anteriorly and a looped, extra-synovial hamstring autograft. Femoral fixation was achieved using an non-absorbable interference screw. Mean age was 25.5 years, with a mean follow-up of 21.7 months. Mean Kujala scores were 60.8 preoperatively and 87.9 postoperatively (p<0.0001). No patient experienced further dislocation or patella fracture post-operatively. One patient required interference screw removal. The surgical technique presented has outcomes comparable with the literature. It requires a shorter tendon graft, and removes the need for a patellar fixation device, reducing potential irritation and cost