Recurrent patellofemoral instability is a multifactorial condition. A stepwise, individualized approach to correct each anatomic factor has become the standard of care. However, each additional surgical procedure to normalize the bony anatomy may increase the complication rate. This chapter reviews the intraoperative and early postoperative complications associated with medial patellofemoral (MPFL) reconstruction, distal realignment with tibial tuberosity osteotomy (TTO), and deepening trochleoplasty. Since most of the complications that can occur are the result of technical pitfalls, special attention is given to how to avoid them. Although MPFL reconstruction has become the standard of care for patellar instability, up to one-third of patients complain of anterior knee pain after surgery. The most common causes are failure to recognize and treat additional contributing factors, femoral tunnel malposition, overtensioning of the reconstruction, and iatrogenic injury to the infrapatellar branch of the saphenous nerve. Similarly, TTO carries its own risk of potential complications, most of which are bony. These include nonunion, secondary displacement, fracture of the osteotomized plate, fracture of the proximal tibial diaphysis, and overcorrection. Interestingly, although trochleoplasty is a very delicate procedure, specific intraoperative complications that could lead to early osteoarthritis are rarely reported. Careful handling of the cartilage during the correction process is essential. The most commonly reported early postoperative complication is arthrofibrosis. Open discussion with the patient before surgery is necessary to select a surgical plan that balances risks and benefits. The need for immediate, regular, nonaggressive postoperative physiotherapy and the need to respect restrictions should also be stressed.