Controlled Tensioning Medial Patellofemoral Ligament Augmentation Using Double‐Tape Suture and Arthroscopic Lateral Soft‐Tissue Release for Patellar Instability

Overtensioning the medial patellofemoral ligament during reconstruction is a key cause of patellofemoral overload, anterior knee pain, and limited flexion. We present a reproducible, tension‐calibrated augmentation technique using a single 4.75‐mm SwiveLock anchor preloaded with double FiberTape and sutures—eliminating graft harvest. This technique is intended as an augmentation rather than a full ligament substitution. The staged fixation strategy, combined with arthroscopic evaluation and selective lateral release, serves to minimize the risk of medial overconstraint. The anchor is placed at the Schöttle point, and sutures are passed subcapsularly to the medial patella, exiting through two 2.5‐mm transverse bone tunnels. Initial lateral knot fixation is performed, followed by stepwise lateral release and vastus lateralis detachment to relieve residual lateral tension. Final FiberTape fixation is completed under arthroscopic visualization, allowing real‐time adjustment to avoid overtightening. Final fixation was performed at approximately 30° of knee flexion, with the patella centered within the trochlear groove. This technique restores patellar tracking, permits full flexion, and may help reduce the risk of recurrence in recurrent patellar instability.