Uploaded November 2025 | Updated September 2026, 2 weeks ago
This video provides a full, step‑by‑step demonstration of All‑Onlay MPFL Reconstruction, highlighting the advantages of using double knotless Knee FiberTak® anchors for both patellar and femoral fixation.
This modern technique creates a broad, continuous onlay construct that improves graft stability, enhances isometry, and reduces surgical invasiveness.
The procedure begins with the preparation of three anchors—two for the patella and one for the femur—along with the associated drill guides, K‑wires, and fiber snares. Using a pull‑in technique, the surgeon unloads the anchor to expose the apex, allowing a transosseous pull‑through using a FiberWire ® suture. A 2.6 mm socket is drilled at the patella, and the K‑wire is advanced laterally until its tip exits the skin without requiring a formal lateral incision. The anchor is then pulled into position slowly and steadily, ensuring proper deformation and seating within the socket. A second anchor is placed approximately 15 mm superior to the first, maintaining parallel trajectory to avoid convergence.
The femoral anchor is placed next. After identifying the medial epicondyle and dissecting between the VMO and the capsule, the surgeon passes two FiberSnare® sutures for graft shuttling. Using fluoroscopy, Shottle’s point is confirmed as the optimal location for femoral fixation. A 2.4 mm Beath pin is advanced, followed by drilling and insertion of a 2.6 mm knotless FiberTak®. Proper resistance during malleting confirms secure seating.
Once all anchors are placed, attention shifts to graft passage. A semitendinosus allograft, approximately 6 mm in diameter and 240 mm in length, is shuttled through the medial soft‑tissue layers using reversed FiberSnare® suture. The graft limbs are then threaded through the loops of the femoral anchor, creating two points of fixation at the apex. With the knee flexed to 20–30°, the patella is manually reduced into the trochlea while graft tension is adjusted to achieve ideal isometry.
A major advantage of this method is the ability to use double knotless loops for a broad onlay construct. After securing the femoral apex, each graft limb is passed through the opposite anchor loop, forming a continuous figure‑eight‑style footprint. This enhances fixation, distributes load, and improves long‑term stability. Final cinching is performed sequentially while protecting against over‑tensioning by maintaining an instrument inside the loop during tightening.
The surgeon completes the procedure by checking graft isometry throughout full knee motion and confirming patellar stability. The reconstruction behaves like a strong “seatbelt,” permitting earlier postoperative motion—often full range by two weeks—thanks to the robustness of the all‑onlay construct. Excess graft tails are trimmed and sutured down to finalize the repair.
👇 Helpful Arthrex Reference Links:
Knee Ligament Reconstruction Solutions: arthrex.com/knee
Learn more: arthrex.info/4i4GO0C
👍 Like this video if you found the surgical technique helpful
💬 Comment with your MPFL reconstruction questions
🔔 Subscribe for more knotless ligament reconstruction videos
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
This video provides a full, step‑by‑step demonstration of All‑Onlay MPFL Reconstruction, highlighting the advantages of using double knotless Knee FiberTak® anchors for both patellar and femoral fixation.
This modern technique creates a broad, continuous onlay construct that improves graft stability, enhances isometry, and reduces surgical invasiveness.
The procedure begins with the preparation of three anchors—two for the patella and one for the femur—along with the associated drill guides, K‑wires, and fiber snares. Using a pull‑in technique, the surgeon unloads the anchor to expose the apex, allowing a transosseous pull‑through using a FiberWire ® suture. A 2.6 mm socket is drilled at the patella, and the K‑wire is advanced laterally until its tip exits the skin without requiring a formal lateral incision. The anchor is then pulled into position slowly and steadily, ensuring proper deformation and seating within the socket. A second anchor is placed approximately 15 mm superior to the first, maintaining parallel trajectory to avoid convergence.
The femoral anchor is placed next. After identifying the medial epicondyle and dissecting between the VMO and the capsule, the surgeon passes two FiberSnare® sutures for graft shuttling. Using fluoroscopy, Shottle’s point is confirmed as the optimal location for femoral fixation. A 2.4 mm Beath pin is advanced, followed by drilling and insertion of a 2.6 mm knotless FiberTak®. Proper resistance during malleting confirms secure seating.
Once all anchors are placed, attention shifts to graft passage. A semitendinosus allograft, approximately 6 mm in diameter and 240 mm in length, is shuttled through the medial soft‑tissue layers using reversed FiberSnare® suture. The graft limbs are then threaded through the loops of the femoral anchor, creating two points of fixation at the apex. With the knee flexed to 20–30°, the patella is manually reduced into the trochlea while graft tension is adjusted to achieve ideal isometry.
A major advantage of this method is the ability to use double knotless loops for a broad onlay construct. After securing the femoral apex, each graft limb is passed through the opposite anchor loop, forming a continuous figure‑eight‑style footprint. This enhances fixation, distributes load, and improves long‑term stability. Final cinching is performed sequentially while protecting against over‑tensioning by maintaining an instrument inside the loop during tightening.
The surgeon completes the procedure by checking graft isometry throughout full knee motion and confirming patellar stability. The reconstruction behaves like a strong “seatbelt,” permitting earlier postoperative motion—often full range by two weeks—thanks to the robustness of the all‑onlay construct. Excess graft tails are trimmed and sutured down to finalize the repair.
👇 Helpful Arthrex Reference Links:
Knee Ligament Reconstruction Solutions: arthrex.com/knee
Learn more: arthrex.info/4i4GO0C
👍 Like this video if you found the surgical technique helpful
💬 Comment with your MPFL reconstruction questions
🔔 Subscribe for more knotless ligament reconstruction videos
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
