Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability.

There are multiple etiologies for recurrent patellar instability. While patella alta, an elevated tibial tubercle trochlear groove distance, and prior lateral patellar dislocations with medial patellofemoral ligament (MPFL) insufficiency have been shown to be risk factors for recurrent patellar instability, trochlear dysplasia can result in a significant impediment to normal patellar tracking. With the adequate identification of risk factors, appropriate surgical treatments can be individually tailored to the patient. We present a combined surgical technique of a sulcus-deepening trochleoplasty using knotless suture anchors for fixation, with MPFL reconstruction using gracilis autograft through short, oblique patellar bone tunnels to address severe trochlear dysplasia.