Purpose <p>Medial patellofemoral ligament reconstruction is an effective technique for treating patellar dislocation, and this study aims to evaluate the relationship between radiographic images at various distal femur angles and true lateral views to improve the accuracy of localizing the lateral femoral point during surgery.</p> Methods <p>Four human cadaveric femora were used in this study. Radiographs of the distal femur were taken in hip adduction–abduction and internal–external femoral rotation at 1° intervals up to 15°. The distance between the internal and external femoral condyles was measured at different rotation angles and compared to the anterior–posterior diameter and height of the lateral femoral condyle.</p> Results <p>The distance between the internal and external femoral condyles showed a linear relationship during hip adduction–abduction and femoral internal–external rotation. In hip adduction–abduction, it changed by approximately 1.343 ± 0.034% of the anterior–posterior femoral diameter per 1° of rotation, and by 2.297 ± 0.067% of the lateral femoral condyle height per 1° in internal–external rotation.</p> Conclusion <p>This study demonstrates a linear relationship between the distance of the femoral condyles during hip adduction–abduction and femoral internal–external rotation, with a greater sensitivity observed during internal–external rotation. Our study offers important insights that may improve surgical precision and contribute to optimizing clinical outcomes.</p> Level of evidence <p>IV.</p>