22-year-old woman was diagnosed with combined MPFL injury (complete MPFL tear at its femoral attachment and patellar insertion) in acute first-time LPD.After 7 months, she had recurrent LPD. Axial fat-saturated proton density-weighted fast spin-echo imaging sequence shows complete discontinuity of MPFL at its patellar insertion and femoral attachment with retraction of fibers and extensive surrounding edema (arrows) in first-time LPD. Note also small avulsion fracture from medial margin of patella.