I’m doing a little research to find out how to cure a chronically dislocating knee cap. I’ve tried the rehab route. It didn’t work for me. I think my knee is too far gone. The ligament and the connective tissue (I think it’s called the retinaculum) are both fully ruptured. That brings me to the possibility of surgery. But I’m finding lots of different ways to do this. I was surprised to see that even in other countries surgeons do it differently. I found one method using the quadriceps muscle that made sense to me. What do you think about this?

There is a stabilizing ligament known as the medial patellofemoral ligament or MPFL that helps keep the patella (knee cap) tracking up and down over the knee. When the patella is dislocated, this ligament is almost always ruptured. And once a ligament is torn, it does not repair or heal itself. Chronic, recurrent patellar dislocation with MPFL rupture is referred to as medial patellofemoral insufficiency.

In order to regain patellar stability and prevent repeated dislocations (ligament insufficiency leading to patellar instability), (surgical) reconstruction is needed. As you are finding out, there are many different ways to reconstruct the damaged ligament. Most techniques involve a tendon graft to replace the ligament. Attaching the graft in place (called fixation) creates problems of its own. That’s one reason why surgeons are looking for better ways to accomplish the reconstruction procedure.

You are indeed correct that all around the world, surgeons are working to find better ways to reconstruct the medial patellofemoral ligament (MPFL). We reported on a previous study from China on this topic. Now there is another from India dealing with the type of graft you mentioned called the Superficial Quad Technique.

In a study from the Saumya Orthocare: Centre for Advanced Surgeries of the Knee Joint in India, one surgeon investigated the use of the superficial quad technique. A superficial slip of the quadriceps tendon is used as the graft. The quadriceps muscle is the large four-part muscle along the front of the thigh. The quadriceps tendon attaches to and around the patella. There are five advantages or “plusses” to this new technique.

First, the graft is a better anatomic match to the original medial patellofemoral ligament (MPFL) in terms of width, breadth, and length. The natural or native MPFL is thin, broad, and sheet-like; so is the quadriceps slip used in this procedure. Two, the superficial quadriceps tendon graft is not as stiff as the commonly used hamstring tendon graft. A strong, stiff graft puts more load on the patellofemoral joint and can cause patellar fracture later.

Three, the superficial quadriceps graft does not have to be held in place with screws or wires. This makes it possible to attach the graft to the medial border of the patella where the MPFL is located normally. The result is a more accurate re-creation of patella biomechanics and elimination of complications from patellar fixation. This is helpful because most common problems that develop after MPFL reconstruction can be traced back to either the type of graft material or the way in which the graft is held (i.e., fixation technique used) in place.

Four, the graft can be harvested arthroscopically with a very small incision. And five, at least in the short-run (first three years), the results are equal to outcomes when compared with using the hamstring tendon.

In the follow-up of the 32 patients in this particular study, no one had recurrent patellar dislocations or other patellar complications. One-fourth of the group had problems bending the knee fully and went to physical therapy to resolve the issue. The author suggests that future improvements of the superficial quadriceps procedure (e.g., better fixation points at the femur, elimination of scarring, better arthroscopic techniques) may help prevent this complication and further improve results.