Table 1.

Pearls and Pitfalls of PMC Reconstruction

Pearls	Pitfalls
A thorough physical exam, supplemented with stress radiographs and MRI, is essential for an accurate and complete diagnosis of a medial-sided knee injury.	MCL reconstruction may be compromised by nonanatomic tunnel placement. Verify that the guide pins are in the correct anatomic placement prior to drilling.
Medial sided femoral tunnels should be drilled by aiming anteriorly and proximally.	The sMCL tunnel should be aimed transversely across the tibia and 30° distally to reduce the risk of sMCL and POL tunnel convergence.
Posterior placement of the sMCL graft tibial insertion more closely reproduces native anatomy and decreases the risk of graft failure.	If chronic limb malalignment is not addressed before or concurrently with the reconstruction, there is increased risk of graft stretching or failure.
Passing sutures should be left in place after each tunnel is drilled to assist with later graft passage.	Failure to properly remove all soft tissue from tunnels may impede graft passage.