Fig. 4

A The solid black lines indicate the surface projections of the actual patellar and tibial tuberosity positions, and the dashed lines indicate the projected postoperative surface projections of the patella, patellar tendon, and tibial tuberosity. B The long nose (inferior pole of the patella) was resected and it was approximately 17 mm in length without articular cartilage attachment. C Intraoperative view shows that the tibial tubercle osteotomy involves distalization and medialization; two screws are well positioned in the fragment. D The repeat arthroscopic exploratory procedure shows the patellar trajectory aligns centrally within the femoral trochlear during both flexion and extension movements; yellow arrow sagittal dimension, red arrow articular surface. E Dynamic medial patellofemoral ligament reconstruction technique involves the gracilis tendon, which was threaded around the incised sartorius fascia and then passed beneath the skin to reach the medial patellar margin