Table 1.

Complications related to errors in diagnosis and judgment

Complication	Clinical effect	Prevention	Detection	Remedy
Medial laxity persists [3, 4, 6, 9, 11, 12, 14]	Symptoms unchanged	Use correct indications: only clinical indication for isolated procedure is lateral patellar compression syndrome, occasional adult patient with refractory recurrent instability [19]; otherwise adults or children with acute or recurrent instability warrant medial tightening or stabilizing procedure; physical examination of excessive lateral translation of patella with neutral or positive tilt warrants medial tightening or stabilizing procedure; medial tightening procedures include medial retinacular imbrication and medial patellofemoral ligament (MPFL) (Fig. 1) reconstruction or repair	Postoperative symptoms unchanged from preoperative owing to medial laxity: pain, patella instability	Repeat surgery with medial tightening procedure, rehabilitation, alternative interventions appropriate to diagnosis
Failure to identify medial patellar or trochlear chondral damage [4, 15]	Transfer pain to medial patellofemoral joint	Thorough arthroscopic evaluation and preoperative imaging examinations to rule out medial chondral injury and abort release if other options available	Postoperative symptoms of medial patellofemoral pain, increased patellofemoral crepitation, increased swelling, or increased pain over medial patellar facet and trochlea by examination	NSAIDs, viscosupplementation, arthroscopic debridement or microfracture of medial lesion
Failure to identify patellofemoral arthritis [1, 3, 7, 8]	Continued pain	Do not perform in patients with moderate patellofemoral arthritis by imaging and arthroscopic assessment	Pain/dissatisfaction with procedure	NSAIDs, viscosupplementation, steroid injection, patellofemoral replacement
Failure to identify hypermobile patella [3, 4, 7, 8, 13]	Patella medially unstable	Thorough physical examination, history; medial patellar glide less than two quadrants, patellar tilt negative	Postoperative medial instability	Physical therapy with lateral strengthening, bracing, revision partial lateral retinacular repair
Inadequate postoperative motion/rehabilitation [3, 4]	Symptoms unchanged	Initiate immediate postoperative motion	Postoperative examination similar to preoperative; postoperative motion needed to maintain separation of retinacular incision to optimize lengthening of retinaculum; keeping the knee in extension after surgery may result in some healing of the retinaculum with little separation thereby defeating the purpose of the release	Physical therapy, repeat surgery