Chronic patellofemoral instability is a multifactorial condition characterized by recurrent dislocation or subluxation of the patella, leading to pain, functional impairment, and an increased risk of osteoarthritis. The etiology involves a combination of anatomical, biomechanical, and neuromuscular factors, including trochlear dysplasia, increased lateralization of the tibial tubercle, patella alta, and ligamentous laxity. Diagnosis relies on clinical assessment and imaging techniques to evaluate structural abnormalities. Acute patellar dislocations are treated non-operatively. Recurrent dislocations may require surgical intervention such as medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle osteotomy, trochleoplasty and lateral retinaculum release. Surgical decision-making depends on patient-specific anatomical considerations, with an emphasis on restoring patellar stability while preserving joint function.