Medial Patellofemoral Ligament Reconstruction Using Gracilis With Pes Anserinus Preservation and Adductor Magnus Pulley

Recurrent patellar instability is a common orthopaedic condition, particularly in young and active patients. Medial patellofemoral ligament (MPFL) reconstruction has emerged as the gold standard for surgical management in cases of objective instability. In this technical note, a quasianatomic MPFL reconstruction is described using an autologous gracilis tendon with preservation of its distal insertion. The graft is passed behind the adductor magnus to replicate the native femoral MPFL path, avoiding femoral tunnel drilling. It is passed in a subretinacular plane and fixed to the patella through convergent bone tunnels using high-strength sutures (FiberWire; Arthrex, Naples, FL). This minimally invasive, implant-free technique preserves graft vascularity, reduces surgical morbidity, and offers a biologically favorable alternative to traditional MPFL reconstruction, particularly in skeletally immature patients.