There are many rigging tuts that encourage mirroring bones in such a way that the same rotation values on opposite joints result in a mirror rotation.
for example if elbows bend along the Z axis then you want a +Z rotation to produce a mirrored behavior in both arms.
With Mirrored 3ds max bones, things are opposite by default. +Z would rotate one arm forward and rotate its mirror back
I compensated for this by rotating the opposite bones to compensate
but the result meant that all my control rig building scripts needed to special case the opposite limbs
and suffer through wierd behavior when adjusting the rotated bones.
now I have a legacy mess to maintain, and I miss Maya.
In the future, with a clean slate, I would probably leave max bones at their default
and put the mirrored axis behavior into the control objects alone, using a relative orient constraint.
actually, I’d probably avoid max bones altogether and just use geo, which would give me a “Y” bone axis