Fig. 2

A 2-cm longitudinal incision was made at the medial border of the patella. The deep fascia and periosteum were detached and reflected medially. After minimal decortication of the reconstruction area, 2 suture anchors were inserted into the proximal margin and center of the medial aspect of the patella (a). The free graft ends were sutured to the inserted grafts after flipping them over through the detached periosteum (b and c). Looped graft with the adjustable-length loop device at the ending was brought into the separated layer between the vastus medialis obliquus (VMO) and the joint capsule, using long curved Kelly with caution to avoid any injury to the joint (d)