Table 2.

Pearls and Pitfalls of Combined Anatomic Medial Patellofemoral Complex Reconstruction

Pearls

In the proximal two-thirds of the patella, the surgeon should drill 2 convergent holes with the minimum diameter needed to pass the graft.

A cortical bone bridge of 10 mm should be left between the tunnels made in the patella to minimize the risk of fracture.

The graft should always be passed into the patellar tunnel by pulling downward from anterior to medial to avoid stress on the tunnel’s roof (anterior surface of the patella).

The graft should be passed through the interval between layers 2 and 3 of the medial retinaculum toward the area of the medial femoral origin.

Pitfalls

Failure to recognize and correct other major causal factors of patellar maltracking must be avoided.

Nonanatomic tunnel or fixation placement, related to an inadequate understanding of the anatomy or inaccurate radiographic localization, must be avoided.

During preparation of the 2 patellar tunnels or during passage of an oversized tendon graft through a tight patellar tunnel, the bone bridge overlying the patellar tunnel is at risk of fracture.