Table 1.

Tips, Pearls, Contraindications, and Pitfalls

• Tips and pearls

1.Palpate the adductor magnus tendon before making the incision, and then make a long enough incision to define the adductor tendon insertion accurately.

2.Be sure to grasp the entire tendon graft when pulling it under the VMO to avoid stripping the tendon.

3.Place a pilot stitch to hold the tendon graft at the desired location and tension in the quadriceps tendon; then, monitor patella tracking arthroscopically to ensure precise graft fixation tension. Check again after all sutures have been placed.

4.Use anteromedialization of the tibial tubercle to tip up the patella selectively off of a symptomatic distal and/or lateral patella articular lesion.

5.Use lateral release cautiously and selectively. Do not over-release. Lateral support is important too.

• Contraindications

1.Do not reconstruct the MQTFL or MPFL alone without ensuring balanced tracking of the patella in the femoral trochlea first using tibial tubercle transfer selectively.

2.MQTFL or MPFL reconstruction alone is more likely to fail in patients with severe trochlea dysplasia or lower extremity dyskinesia.

• Pitfalls

1.Inadequate dissection and failure to accurately isolate adductor tendon

2.Overtensioning graft or pulling patella onto a symptomatic patella articular lesion

3.Failure to correct underlying malalignment

4.Excessive lateral release, overtensioning of graft, or excessive tubercle medialization, leading to medial patella subluxation