Patellofemoral instability is a complex orthopedic condition characterized by the misalignment or displacement of the patella relative to the femoral groove, often resulting in pain, dysfunction, and episodes of dislocation or subluxation. The etiology of patellofemoral instability is multifactorial, involving anatomical, biomechanical, and traumatic factors. Anatomical alterations such as trochlear dysplasia, patella alta, lower limb malalignment, and ligamentous laxity are frequently observed in affected patients. Additionally, traumatic injuries can precipitate acute episodes of patellar dislocation. The diagnosis of patellofemoral instability combines a detailed medical history, thorough physical examination, and imaging studies, including X-rays, computed tomography (CT), and magnetic resonance imaging (MRI), highlighting the potential use of instrumented MRI (Porto Patella Testing Device). The evaluation should focus on identifying risk factors and characterizing the degree of instability. The treatment of patellofemoral instability is individualized and may include conservative and/or surgical approaches. Conservative treatment often involves targeted physiotherapy to strengthen muscles and correct biomechanical imbalances. When conservative measures fail or in initially selected cases, surgical procedures such as isolated or combined medial patellofemoral ligament reconstruction, anterior tibial tuberosity osteotomies, and trochleoplasty may be indicated.