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Background: The role of medial patellofemoral ligament reconstruction in reestablishing patellofemoral joint stability has recently been reported with Increasing frequency. The purpose of this study was to review the reported complications of medial patellofemoral ligament reconstruction, highlight the common technical errors, and discuss the potential complications that can arise from this procedure. Methods: We review the literature on medial patellofemoral ligament reconstruction, including the reported causes of failure. In addition, we present three cases and discuss the multiple factors that are crucial for success, Including patient selection, tunnel placement, graft isometry, and determination of the need for concurrent realignment surgery. Results: The principles of surgical management require a thorough understanding of proper patient selection and of the Interaction between the roles of the osseous and soft-tissue restraints on the patella. Creating a logical treatment algorithm based on pathoanatomy can elucidate the need for concurrent distal realignment procedures. Tunnel positioning is critical in recreating appropriate patellofemoral alignment. The reported complications Include patellofemoral arthrosis, graft Impingement, and graft failure. Conclusions: Many of the complications that can arise from medial patellofemoral ligament reconstruction are the result of technical error and can be avoided by understanding the potential complications associated with this procedure. [ABSTRACT FROM AUTHOR]