Purpose of review <p>Lateral patellar instability is one of the most common knee conditions among adolescents, with an estimated incidence of approximately 43 per 100,000 individuals. Trochlear dysplasia has been identified as the most common anatomic risk factor for patellar instability and may be present in up to 90% of patients with lateral patellar instability. It presents across a spectrum of severity ranging from mild to severe. While multiple surgical treatment algorithms exist for managing patellar instability, trochleoplasty remains the only procedure that directly addresses the underlying trochlear pathology and restores normal patellar tracking. The purpose of this review is to highlight the critical role of trochlear dysplasia in patellar instability and to review the indications, surgical technique, and contemporary role of trochleoplasty in the management of this condition.</p> Recent findings <p>Recent studies report favorable short, mid and long term clinical outcomes following trochleoplasty in patients with lateral patellar instability associated with trochlear dysplasia. In parallel, emerging biomechanical and radiographic evidence has further clarified the role of trochlear dysplasia in increasing patellofemoral contact pressures and altering patellar tracking, while also demonstrating favorable radiographic outcomes following trochleoplasty. Together, these findings reinforce the importance of addressing the primary trochlear pathology in patients with lateral patellar instability, particularly in the setting of moderate- to high-grade trochlear dysplasia, and support a treatment paradigm that prioritizes correction of the underlying anatomic abnormality. Recent findings</p> Summary <p>Lateral patellar instability is a multifactorial condition in which trochlear dysplasia represents a primary anatomic contributor to recurrent instability and altered patellofemoral biomechanics. Recent biomechanical, radiographic, and clinical evidence supports a pathology-driven approach to management, emphasizing the importance of directly addressing trochlear morphology in appropriately selected patients. Although the procedure is technically demanding, careful patient selection and surgeon expertise can result in good to excellent clinical outcomes and potential long-term preservation of patellofemoral cartilage.</p>