*4.10.5 Step 5: Femoral Tunnel Formation, Graft Preparation, and Femoral Graft Fixation*

An incision is made over the site of anatomic origin of the MPFL on the femur. A guidewire is placed to approximately 30 mm of depth at the anatomic attachment of the MPFL on the femur, which can be identified in the saddle area proximalposterior to the medial epicondyle and distal-anterior to the adductor tubercle (Kruckeberg et al. 2018). The femur is drilled and the drill hole is tapped. One end of the whip stitch applied to the gracilis tendon autograft is loaded through a 7 mm × 23 mm MILAGRO interference screw (DePuy Mitek) with the assistance of the CHIA PERCPASSER suture passer (DePuy Mitek). The tendon graft is then pushed into the drill hole with a pickup or a freer, and the screw is advanced until flush with the cortex of the femur (**Figure 10A** and **B**). A free needle is used to sew

#### **Figure 10.**

*(A) With the patient supine and the left knee in 45° of flexion, an incision is made over the saddle area proximal-posterior to the medial epicondyle and distal-anterior to the adductor tubercle on the femur. A guidewire is placed to approximately 30 mm of depth, the femur is drilled, and the drill hole is taped. One end of the whip stitch applied to the gracilis tendon autograft is loaded through a 7 mm × 23 mm interference screw (DePuy Mitek) and the tendon is dunked into the drill hole. (B) The screw is advanced until flush with the cortex of the femur. Reproduced with permission from: Kurowicki et al. [130].*

the unused end of the suture through the graft, and it is tied to the end that was previously passed through the suture anchor.
