» Both medial patellofemoral ligament reconstruction (MPFLR) and medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) reliably restore patellar stability, with low redislocation rates and comparable improvements in patient-reported outcomes when performed with anatomic technique and appropriate graft tensioning. » MQTFLR avoids patellar drilling and may more closely reflect native medial patellofemoral complex anatomy, making it an attractive option in skeletally immature patients, individuals with compromised patellar bone stock, and select revision settings. » Biomechanical studies demonstrate that MQTFLR more closely reproduces native patellofemoral kinematics, while MPFLR may introduce mild medial overconstraint when femoral fixation is nonanatomic or graft tensioning is excessive, although these differences have not translated into consistent clinical outcome disparities. » Combined MPFL-MQTFL reconstruction distributes medial restraint across proximal and distal components of the medial patellofemoral complex but has not consistently demonstrated superior clinical outcomes compared with isolated reconstruction and introduces additional operative complexity. » Optimal surgical outcomes depend more on patient selection, accurate femoral fixation, and appropriate graft tensioning than on the specific choice of patellar-based versus quadriceps-based fixation, emphasizing individualized decision making based on anatomy, skeletal maturity, and clinical context.
Krish et al. (Wed,) studied this question.