Table 2.

Advantages, Disadvantages, Risks, and Limitations

1.The advantage of transphyseal screw for hemiepiphysiodesis is that it would not interfere with the placement of the MPFL graft, compared with a tension-band plate.

2.Compared with a tension-band plate, the transphyseal screw would not cause knee joint irritation or stiffness and would be inserted percutaneously.

3.The transphyseal screw should be avoided in very young children due to the risk of permanent physeal damage. The tension-band plate is a safer alternative.

4.The gracilis graft length may be inadequate if more graft is placed in the patellar tunnel or in larger patients. The alternative graft choices are semitendinosus, quadriceps tendon, patellar tendon or allograft.

6.In patients with physiologic hyperlaxity, there is a risk of stretching of the gracilis autograft over time. Allograft can be considered in these patients.

7.There is a risk of patellar fracture due to patellar tunnel placement. An alternative to patellar tunnel placement is to suture the graft to the periosteum, use suture anchors, or tunnel the graft through quadriceps tendon.

8.There is a risk of injury to the distal femoral physis during femoral tunnel placement.

9.There is a risk of change in MPFL graft position and isometricity with continued skeletal growth and with gradual correction of genu valgum. Staged surgery could be considered as an alternative.

10.Fluoroscopic identification of MPFL femoral tunnel landmarks has its limitations. An open approach to identification of MPFL femoral tunnel landmarks could be used as an alternative.

MPFL, medial patellofemoral ligament.