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The tendons of tibialis anterior and of extensor digitorum. longus, and the muscle and tendon of extensor hallucis. longus and peroneus tertius, lie beneath the superior exten-. sor retinaculum (anterior crural ligament) (Fig. 1).
The medial patellofemoral ligament, which is part of the medial retinaculum, is the main injured structure especially regarding normal knee alignment. Therefore, medial retinacular plication, a proximal realignment correction technique, can directly address the main pathology of patellar instability.