Table 2.

Tips, Pearls, Contraindications, and Pitfalls

Tips and pearls

Make the vertical incision 2 to 3 cm proximal to the superior patellar pole because the superficial slip of the tendon is easiest to differentiate at this level.

During superior dissection of the graft, provide adequate superior exposure to achieve an adequate length of graft.

Try to identify the femoral insertion under fluoroscopy; a true lateral view is necessary to accurately place the drill hole.

Aim the guidewire toward an exit point on the anterolateral femur to avoid the neurovascular structures of the popliteal groove.

Secure the graft within the medial condyle tunnel with the knee flexed to 30° to avoid overtensioning.

Contraindications

If additional risk factors such as torsional malalignment are not taken into consideration, the reconstruction is prone to failure.

MPFL reconstruction with the quadriceps tendon is more likely to fail in patients with severe trochlear dysplasia.

In patients with congenital dislocation of the patella, an additional soft-tissue release is necessary.

Pitfalls

Inadequate dissection can be performed, resulting in a graft that is too short.

In patients with severe trochlear dysplasia, secondary trochleoplasty after closure of the growth plate might be necessary.

Weakening of the graft at the patellar insertion is possible.

Overtensioning of the graft can occur.

Injury to the distal femoral physis with subsequent growth disturbance is possible.