Combined Trochleaplasty, Lateral Retinacular Lengthening, and Medial Patellofemoral Ligament Reconstruction Using Quadriceps Tendon

Chronic and recurrent patellar instability frequently is associated with trochlear dysplasia, lateral retinacular tightness, and medial patellofemoral ligament (MPFL) insufficiency. Combined surgical correction addressing all pathologic factors is critical to restoring patellar stability. This Technical Note presents a detailed and reproducible surgical technique combining deepening trochleaplasty, lateral retinacular lengthening, and MPFL reconstruction using a quadriceps tendon autograft. Trochleaplasty is performed using a thin-flap technique to create a new, stable trochlear groove. Lateral retinacular lengthening is carried out via a stepwise Z-plasty, and an anatomic MPFL reconstruction is accomplished with a partial-thickness quadriceps tendon graft without patellar bone tunnels. This comprehensive approach aims to restore patellar tracking, reduce pain, and prevent recurrent dislocations. The described technique offers a systematic strategy for treating complex patellar instability while preserving joint congruency and minimizing complications.