Table 2.

Technical Pearls and Pitfalls

Pearls

Graft fixation to the patella can be reinforced by tying sutures at the end of the graft to the surrounding soft tissues.

The femoral tunnel placement can be adjusted if necessary after evaluation of isometry.

A clamp should be placed underneath the graft at the femoral incision site to prevent over-tightening.

Using a true lateral view, the surgeon should identify the Schöttle point for femoral tunnel placement with the help of an MPFL template.

The surgeon should aim the femoral Beath pin anteriorly and proximally to increase tunnel length and avoid the notch or posterior cortex of the femur.

Pitfalls

Penetration of the anterior cortex is possible while drilling the patellar tunnel. Excessive and/or incorrect drilling increases the risk of patellar fracture.

Over-tightening the graft may lead to excessive medial restraint.

Disruption of the vastus medialis on the MPFL is possible owing to superficial dissection between the patellar and femoral incisions.

Proximal pin placement on the femur can occur, resulting in tightness during knee flexion.

The femoral tunnel should be not reamed through the lateral cortex.

MPFL, medial patellofemoral ligament.