Patellofemoral dysplasia is a complex and debilitating condition that can significantly impact the quality of life. Abnormalities in the morphology and alignment of the patella and femur characterize this condition. Abnormal patellar tracking is the etiology of most patellofemoral pathology, culminating in frank dislocation. Although patellofemoral instability is among the most prevalent knee disorders, the management of these patients remains highly variable due to its complex nature and often reflects an incomplete understanding of the condition. A deep understanding of normal and pathological anatomy and biomechanics is the key to achieving a personalized patient approach addressing each anatomical factor responsible for the symptoms as per the Lyon School of Knee Surgery à la carte philosophy. The objective of this chapter is to offer the reader an up-to-date understanding of this condition, with an overview of patellofemoral anatomy, development, and kinematics before suggesting appropriate clinical evaluation and management. This chapter will provide the reader with a practical guide for managing PF joint instability in clinical practice.