Ipsilateral tucking of the superior oblique tendon, as recommended by Knapp, addresses all aspects of the motility disturbance in patients with a Knapp class II superior oblique muscle paresis. However, tucking the superior oblique tendon remains controversial in some situations. Plager, Helveston, and colleagues2- 5,15 have reported that many patients with congenital superior oblique muscle paresis have a lax or redundant tendon. They advise that patients with tendon laxity should have a tucking procedure and those without should not. Although this recommendation is becoming an often-repeated dogma, it has never been clinically tested. The teaching is predicated on the belief that the primary anomaly in these patients is a lax tendon,2- 5 and if the laxity is taken up with a tucking procedure, the muscle will function more normally. However, Sato has shown that patients with a lax tendon typically have an atrophic superior oblique muscle, as seen on imaging studies, and hence the tendon laxity may be secondary.29 If that is the case, the rationale for only tucking lax tendons is less compelling. One could argue that tucking tendons that are not lax might be more likely to result in improved function, as the muscle itself may only be paretic and still have some function. This is similar to the principle that a mildly paretic lateral rectus muscle may be strengthened by a resection but a completely flaccid one will not. In fact, there are multiple reports of good results with tucking the superior oblique tendon to treat superior oblique muscle paresis without limiting the indication to patients with lax tendons.11- 12,27,30- 32 Irrespective of this argument, there are many clinicians who always avoid tucking the superior oblique tendon10,13 and others who avoid it if laxity is not found.2- 5,15 For these surgeons, an alternative procedure would be useful.