The clinical presentation of an overtight medial patellofemoral ligament (MPFL) reconstruction can differ depending on whether it is too tight in extension (extensor lag) or too tight in flexion (anterior knee pain and loss of flexion). We report one clinical case of each presentation. Both cases were treated with a percutaneous release of the graft. After the release, both patients regained a full active range of motion without residual symptoms. These complications demonstrate that the adjustment of the graft tensioning as well as its femoral position are critical steps in MPFL reconstruction. This procedure requires training and experience in order to avoid early complications related to malposition or inappropriate tensioning of the graft. A surgical management for these overtight reconstructions is recommended, as it will restore function and range of motion, and prevent late patellofemoral degeneration.
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