Editorial Commentary: Proper Femoral Tunnel Placement for Medial Patellofemoral Ligament Reconstruction Requires Optimal Radiographic Technique.

Femoral tunnel malposition has been shown to be a risk factor for medial patellofemoral ligament reconstruction failure. Palpation of the "saddle point" between the adductor tubercle and medial epicondyle can be an effective strategy; however, compared to using fluoroscopy, tunnel placement using palpation alone may result in significantly more frequent malposition. Accordingly, use of radiographic landmarks has gained in popularity. However, the technique is not without its pitfalls. The first issue lies with obtaining an adequate x-ray. Deviation from a true lateral x-ray by as little as 5° can result in significant tunnel malposition. Including sufficient visible femoral shaft is also required; a minimum requirement is 4 cm. The literature widely varies as to the anatomic, fluoroscopic position. Schottle's point (1.3 mm anterior to the posterior cortical extension line) is the most well studied.