. 2024 Jan 1;13(3):102875. doi: 10.1016/j.eats.2023.11.003

Table 2.

Pearls and Pitfalls

Pearls	Pitfalls
• Use fluoroscopy to ensure that the anchors are in the superior half of the patella and in the midpoint of the patella in the anteroposterior direction to minimize the risk of fracture. • Pass the sutures from the anchors into the graft at the level of the anchor with the patella held in the center of the trochlear groove and in neutral tilt. • Tension the inferior graft limb first and assess patellar translation and tracking. Fine adjustments to the tension of the superior graft limb can be made based on the assessment.	• Avoid passing the sutures from the anchors into the graft too far from the anchor to avoid undertightening and overtightening the graft. • Asymmetric graft limb length at the time of femoral fixation may result in one limb being too short to reach MPFL attachment on patella. A graft length of 18 cm is recommended. • Drilling the two suture anchors in a convergent fashion may result in breakage of the bone bridge between the two anchors. Fluoroscopic guidance is recommended to ensure the anchors are parallel.

Pearls

Pitfalls

•
Use fluoroscopy to ensure that the anchors are in the superior half of the patella and in the midpoint of the patella in the anteroposterior direction to minimize the risk of fracture.
•
Pass the sutures from the anchors into the graft at the level of the anchor with the patella held in the center of the trochlear groove and in neutral tilt.
•
Tension the inferior graft limb first and assess patellar translation and tracking. Fine adjustments to the tension of the superior graft limb can be made based on the assessment.

•
Avoid passing the sutures from the anchors into the graft too far from the anchor to avoid undertightening and overtightening the graft.
•
Asymmetric graft limb length at the time of femoral fixation may result in one limb being too short to reach MPFL attachment on patella. A graft length of 18 cm is recommended.
•
Drilling the two suture anchors in a convergent fashion may result in breakage of the bone bridge between the two anchors. Fluoroscopic guidance is recommended to ensure the anchors are parallel.

MPFL, medial patellofemoral ligament.