 A new cadaver study reported in the American Journal of Sports Medicine reports similar outcomes between two approaches for restoring patellar stability. The traditional technique involves drilling into the patella. The other involves fixation to soft tissue alone. Recurrent instability of the patella represents a challenging problem, especially in children and adolescents. One favorite solution is reconstruction of the medial patellofemoral ligament, or MPFL, which is the primary restraint to lateral patellar translation. This procedure often involves drilling into the patella. Unfortunately, MPFL reconstruction has been reported to involve a relatively high complication rate in young patients. To avoid the risk of patellar fracture, researchers have proposed an alternative procedure. Reconstruction of the medial quadriceps tendon femoral ligament, or MQTFL. This approach involves soft tissue-only fixation, avoiding patellar drilling. To determine how the two techniques compare, researchers tested nine adult knee specimens from cadavers. Each specimen was mounted on a jig that applied static physiologic loads to the quadriceps tendons and was submitted to two tests under four different conditions. Intact, transected MPFL and MQTFL, MQTFL reconstruction, and MPFL reconstruction. The first test was a quasi-static knee flexion test that measured patellar position, orientation, and contact pressure and area as a function of flexion angle. The second test was a lateral patellar excursion test in which a load was applied directly to the patella in the lateral direction with a knee at 30 degrees of flexion. A light quadriceps load was applied to simulate muscle tone. Data showed that MQTFL reconstruction more closely restored the native state in terms of lateral patellar translation. No significant differences were detected between the MQTFL and intact states with a knee at 30 degrees of flexion. In contrast, MPFL reconstruction resulted in increased stiffness with significantly less patellar translation than that in the intact state. Both forms of reconstruction resulted in increased internal rotation of the patella with a knee in full extension. And no differences were observed between the procedures with regard to the mean or peak patello femoral contact pressure. The findings suggest that MQTFL reconstruction recreates the patella's native resistance to lateral translation at the time of surgery. Further research could help researchers better understand how this method of soft tissue only fixation affects clinical outcomes in patients with patellar instability.