The MPFL is the primary static medial patellar stabiliser throughout the early range of flexion before the trochlear groove engages the patella. Its femoral attachment at the adductor tubercle is a precise anatomical point — malpositioned MPFL reconstruction with the graft attachment even 5 mm away from the anatomical insertion point produces abnormal patellar loading. Anatomical MPFL reconstruction using gracilis or semitendinosus graft restores normal patellar tracking.
| Origin | Medial femoral condyle (the adductor tubercle — 1-1.5 cm anterior and distal to the adductor tubercle) |
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| Insertion | Medial patella (proximal two-thirds of the medial border) |
| Actions | The primary static medial restraint against lateral patellar displacement — provides 50-60% of medial patellar stability in the first 30 degrees of knee flexion |
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MPFL reconstruction is the standard surgical treatment for recurrent patellar instability with normal TT-TG distance and normal trochlear morphology. The femoral tunnel is placed at the Schottle point (on lateral fluoroscopy: the intersection of the posterior cortical line of the distal femur and a horizontal line along the distal physis) for anatomical restoration. Combined with tibial tubercle medialization for elevated TT-TG (>20 mm).
MPFL deficiency producing recurrent lateral patellar dislocation managed with anatomical MPFL reconstruction to the Schottle point.
