Table 2.

Advantages and Disadvantages

Advantages	Disadvantages
All-soft-tissue fixation requires no implants.	Looping the graft through both the extensor mechanism and for femoral fixation may require longer graft lengths than in other techniques.
Low cost because of the lack of implants needed.	Placement of a defect in the quadriceps tendon may limit future quadriceps tendon procedures (e.g., ACL graft).
No risk of patella fracture.	The looped graft may feel more prominent on the femur than with the use of bone tunnels.
Excellent option for revision MPFL cases in which adequate bone stock on the medial femur is not available.	This technique may not be useful in cases of severe medial knee (i.e., MCL injury).
Excellent option for skeletally immature knees without abnormal graft function or risk of violating the physis.
No radiographic confirmation of femoral fixation required.

ACL, anterior cruciate ligament; MCL, medial collateral ligament; MPFL, medial patellofemoral ligament.