Medial patellofemoral ligament (MPFL) reconstruction has become a common surgical procedure in the treatment of recurrent dislocation of the patella. A technique of MPFL reconstruction with the "hanger lifting procedure" using extra-articular arthroscopy is presented. After conventional intra-articular arthroscopy, an incision about 1 cm long is made at the superomedial edge of the patella. A bone tunnel is created with a guide pin and overdrilling method, from this portal to the subcutaneous surface of the patella. Using a semi-loop-shaped hanger, the harvested Gracillis tendon is passed through the bone tunnel using a passing pin. Under extra-articular arthroscopy with the "hanger lifting procedure", this tendon is then led back to the superomedial portal. Both ends of the Gracillis tendon are then led to the femoral fixation site posterosuperior to the medial epicondyle with a tendon passer, and fixed by an absorbable interference screw. This procedure can be performed under a minimum incision using a hanger, but control radiographs should be taken to confirm appropriate placement of bone tunnels.
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