**4.2 Medial patellofemoral ligament reconstruction**

While numbers of MPFL reconstructions are reported, this procedure allows doing under a minimum incision. Authors' prefferred method is as follows; a 1 cm incision at the superomedial corner of the patella is made. An oblique bone tunnel through the patella is drilled with a guide pin and overdrilling method. This tunnel should be obliquely routed from the superomedial corner of the patella to the anterior center of the patella, trying to recreate the original fan-shaped attachment of the MPFL (Steensen et al., 2004). The lifting hanger is introduced into the prepatellar space, to be able to perform extraarticular dry arthroscopy. The harvested semitendinosus tendon is introduced to this space through the bone tunnel, pulled using a passing pin (Fig.6).

The suture is caught using a grasper punch from the superomedial portal, and the tendon is drawn out to the superomedial portal, along with the existing end of the tendon (Fig.7).

Fig. 7. A) The tendon passing through the bone tunnel is drawn out to the superomedial portal, which also exists at the other end of the tendon. B) Arthroscopic view between the patella and skin during the operation. In this situation, a hanger, an arthroscope, and forceps are introduced from the same superomedial portal. The forceps are about to grip the

Using a tendon passer, both tendon ends are lead to the femoral fixation site, which is just distal to the adductor tubercle and posterosuperior to the medial epicondyle (Nomura,

Among numbers of bursae existed around the knee, the most problematic bursitis would happen in the prepatellar bursa. The incision should be at the superior and the inferior end of the bursa, with care not to cut the infrapatellar branch of the saphenous nerve. Authors prefer using dye solution prior to resection to help determine the extent of the bursal tissue, as it does not always look like typical bursa. Under dry arthroscopy in the bursa created by

the lifter, bursectomy can be performed using a shavor or an electric coagulator. Putting a drainage tube should also be considered depending on the cases.

sutures connecting the ligament. P, patella; S, subcutaneous tissue.

An interference screw is used to fix the ligament.

2003).

**4.3 Bursectomy** 

Fig. 6. Watching the drilled hole on anterior surface of the patella through the scope, absorbable sutures (No. 2 Vicryl®) connected to semitendinosus tendon is introduced by pulling through the passing pin.

Fig. 6. Watching the drilled hole on anterior surface of the patella through the scope, absorbable sutures (No. 2 Vicryl®) connected to semitendinosus tendon is introduced by

pulling through the passing pin.

The suture is caught using a grasper punch from the superomedial portal, and the tendon is drawn out to the superomedial portal, along with the existing end of the tendon (Fig.7).

Fig. 7. A) The tendon passing through the bone tunnel is drawn out to the superomedial portal, which also exists at the other end of the tendon. B) Arthroscopic view between the patella and skin during the operation. In this situation, a hanger, an arthroscope, and forceps are introduced from the same superomedial portal. The forceps are about to grip the sutures connecting the ligament. P, patella; S, subcutaneous tissue.

Using a tendon passer, both tendon ends are lead to the femoral fixation site, which is just distal to the adductor tubercle and posterosuperior to the medial epicondyle (Nomura, 2003).

An interference screw is used to fix the ligament.
