Table 1.

Pearls and Pitfalls

Step	Pearls	Pitfalls
Preoperative planning	• Consider the underlying etiology.	• In the context of trochlear dysplasia, recurrent dislocation is likely.
	• Template the required patella distalization.	• Indiscriminate medialization will lead to early arthritis.
Osteotomy	• Mark the screw position on the proposed osteotomy fragment before making the bone cuts.	• An osteotomy fragment that is “too thin” increases the chances of nonunion.
	• Keep the coronal cut parallel with the anterior tibia to avoid unintended anterior or posterior translation.	• An uneven coronal osteotomy may permit a pivot point when the fragment is compressed, resulting in fracture.
	• Start the coronal osteotomy and then use the initial cut as a slot for the saw to achieve a flat cut.
Fixation	• Avoid screw prominence and fracture by careful countersinking for the screw heads	• Fracture of the tuberosity fragment (can be addressed with a tension band construct over the screw heads).
MPFL reconstruction	• Assess the patella tracking by superolateral arthroscopy before proceeding to MPFL reconstruction.	• Avert fracture of the patellar tunnel by avoiding an axial plane tunnel. The tunnel should be V-shaped and in the coronal plane.