Although more than 100 operative procedures have been described for the treatment of patellar instability, there is no single universally successful procedure. Careful physical and imaging examination should be performed before the most appropriate operative treatment is chosen. For the patients with patellar instability, who have normal tibial tubercle-trochlear groove (TT-TG) distance, normal patellar height and no marked trochlear dysplasia medial patellofemoral ligament (MPFL) reefing or reconstruction is recomended. In patients who have an increased TT-TG distance or patella alta, distal realignment procedures are used. Because studies have shown that MPFL is the most significant passive stabilizer of the patella, and because they have shown that MPFL is disrupted in majority of patellar dislocation cases most of the authors recommend reefing or reconstruction of the MPFL for the treatment of patellar instability. The purpose of this review is to give an overview of the etiology, diagnosis and treatment of patellar instability determining whether MPFL reefing or MPFL reconstruction is a suitable procedure for the most patients with patellar instability.